Special Enrollment Period
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Medicare Special Enrollment Period
- Special Enrollment Period for Original Medicare
- Special Election (Enrollment) Period for Medicare Advantage and Medicare prescription drug plans
There are cases where you may enroll in Medicare outside of regular enrollment periods due to extenuating circumstances. This is known as the Medicare Special Enrollment Period (SEP). If you qualify for the Medicare Special Enrollment Period, you can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).
There are also Special Election Periods (also known as Special Enrollment Periods) for Medicare Advantage and Medicare prescription drug plans.
Special Enrollment Period for Original Medicare
Delaying Medicare Part B enrollment
One scenario familiar to some people is that they’re still working when they turn 65 – or their spouse is still working. If you’re covered by an employer’s group health plan, you might decide to hold off on enrolling in Medicare Part B until your other health coverage ends. Part B comes with a premium and often has very similar coverage to a group health plan.
If you are 65 or older and are covered under a group health plan, you generally have a Special Enrollment Period during which you can sign up for Medicare Part B. This means that you may delay your decision to enroll in Medicare Part B without having to pay the 10% monthly premium penalty for late enrollment.
Delaying Medicare Part A enrollment
Most people get Medicare Part A without paying a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes. However, if you don’t have enough work history to get premium-free Medicare Part A and delay Medicare enrollment when you turn 65 because you have employer-sponsored coverage, you can also use your Special Enrollment Period to sign up for Part A. Otherwise, a late-enrollment penalty could apply for Medicare Part A if you don’t enroll when you’re first eligible and need to pay a premium.
Under such circumstances, you may:
- Enroll in Medicare Part A and/or Part B any time while you’re covered under the group health plan based on your current employment.
- Enroll in Medicare Part A and/or Part B during the eight-month period that begins with the month your group health coverage ends or the month your employment ends, whichever comes first. Medicare Special Enrollment Period rules do not apply if employment or employer-provided group health plan coverage ends during your Initial Enrollment Period.
If you do not enroll in Medicare by the end of the eight-month period, you will have to wait until the next General Enrollment Period, which begins January 1 of the next year. You also may have to pay a higher premium for Medicare Part B. If you don’t qualify for premium-free Medicare Part A, you may owe a late-enrollment penalty for Part A as well.
People who receive Social Security disability benefits and are covered under a group health plan, from either their own or a family member’s current employment, also have a Medicare Special Enrollment Period. For more information on situations that may qualify you for a Special Enrollment Period, contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; TTY users can call 1-877-486-2048.
Special Election (Enrollment) Period for Medicare Advantage and Medicare prescription drug plans
The Special Election Period (SEP), also called a Special Enrollment Period, for Medicare Advantage and prescription drug plans is generally somewhat different from the Original Medicare SEP.
Typically, the Medicare Advantage/prescription drug SEP applies to those who have lost their coverage. For example, if your plan stopped accepting Medicare or moved out of your area, or if you moved out of the plan’s service area, you might be eligible.
Another situation where you might qualify for a Medicare Advantage/prescription drug SEP is if your area is hit with a natural disaster. For this SEP, there are several restrictions you should be aware of. All of these must be true for you:
- The Federal Emergency Management Agency (FEMA) declared an emergency or major disaster in your county.
- You lived in the affected county when FEMA declared an emergency or major disaster.
- You had a valid election period going when FEMA declared an emergency or major disaster.
- You hadn’t yet changed your coverage when the emergency or major disaster was declared.
- The valid SEP for your situation hasn’t expired.
Medicare information is everywhere. What is hard is knowing which information to trust. Because Medicareprofessionaladvisors are following the CMS regulations, you can rest assured you’re getting accurate information so you can make the right decisions for your coverage.
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Medicare Part A
Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.
Medicare Part B
Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.
Medicare Part C
In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.
Medicare Part D
Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.
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- Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
- Special Enrollment Period (SEP) – Certain life circumstances, including as moving or losing current coverage, may qualify you for coverage. You usually have two months to enrol, depending on your circumstances.
- Medicare Part C & D Annual Enrollment Period (AEP) – Every year, from October 15 to December 7, Existing Medicare beneficiaries can take advantage of this time to review and adjust their Medicare Advantage (Part C) and Medicare prescription medication plans (Part D). You cannot utilise AEP to enrol for the first time in Part A and/or Part B. The following year’s coverage begins on January 1st.
- Medicare General Enrollment Period – Every year, from January 1 to March 31, While the majority of individuals will receive Part B coverage when they join in Medicare, this period is allocated for those who did not enrol in Part B when they initially became eligible. Coverage begins on July 1st of the following year.
- Medicare Advantage Open Enrollment Period (OEP) – Every year, from January 1 to March 31, You can change to a different Medicare Advantage plan with or without medication coverage during this period, or move to Original Medicare and join a separate Medicare Prescription Drug plan. You cannot, however, go from Original Medicare to a Medicare Advantage plan, join a prescription drug plan while on Original Medicare, or change from one prescription drug plan to another prescription drug plan while on Original Medicare.