Individuals have an initial enrollment period available to them to first enroll in Medicare. However, Medicare also allows those in certain circumstances to enroll in Medicare Part B at a later point.
In addition, Medicare also offers special enrollment periods to those already enrolled in Medicare. Each year, Medicare beneficiaries have a chance to change their Medicare plan choices during the annual enrollment period (AEP). Those with Medicare Advantage can also change their Medicare Advantage plan, or return to Original Medicare, during the Medicare Advantage open enrollment period (MA OEP).
But what if you need to make a change to your Medicare plan outside of those dates? The government allows special enrollment periods (SEPs) for specific types of events where you will need immediate coverage before the next annual enrollment.
This guide will help you understand what SEPs are available and how each one works.
It can be very challenging to keep up with which life events qualify for an SEP, especially if you’re in the middle of a move, job change, or other stressful situation. Plus, each SEP has its own rules. That’s why it’s important to know how each one works ahead of time, if possible.
Generally, you sign up for Medicare Part A automatically when you turn 65.
Not everyone retires at or before age 65. If you’re still working after age 65 and are covered under a group health plan, you don’t have to sign up for Medicare right away.
Once you retire and stop working, you have an eight-month special enrollment period to sign up for premium-free Medicare Part A, along with a drug plan (Part D) or Medicare Advantage (Part C) if you prefer.
If you qualify for premium-free Medicare Part A, . you can sign up for it anytime because you don’t pay a premium, although you may have a gap in coverage.
However, if you have to pay a premium for Medicare Part A, you can only sign up during approved enrollment periods or if a special enrollment period is triggered.
Medicare Part B carries a monthly premium, and if you sign up after your initial enrollment period you usually will face a penalty. There are exceptions, though, and many of them apply to events that cause a special enrollment period.
If you’re still working after age 65 and are covered under a group health plan, you may choose to delay signing up for Part B. Once you retire and stop working, you have an eight-month special enrollment period to sign up for Medicare Part B, along with a drug plan (Part D) or Medicare Advantage (Part C) if you prefer.
You get a special enrollment period for Part B if
When you have a Medicare Advantage (MA)plan or a Prescription Drug Plan (also known as Medicare Part D), you can make changes during the normal annual enrollment period. However, there are times when you need to make immediate changes, and a special enrollment period can let you do that.
You can get a special enrollment period for an MA or Part D plan if:
This is not an exhaustive list. If you have questions about Medicare enrollment or want to review your plan options, contact us today!
If there is a Federal, State or locally declared emergency or disaster, the Center for Medicare Services (CMS) will designate a special enrollment period for those who missed their chance to enroll due to that event.
The special enrollment period starts the date the declaration was made and continues for two full months following the end of the declaration. This SEP also applies to those who don’t live in the affected area but rely on people in that area for help with healthcare decisions.
There are a lot of life events that can impact your need for Medicare, and sometimes they happen outside of the normal enrollment timeframes. Special enrollment periods exist to help you get the coverage you need at the right time.
If you have questions about Medicare enrollment or want to review your Medicare Advantage plan options, contact us today!