What to know about the special enrollment periods for Medicare
Medicare offers several enrollment opportunities, including special enrollment periods (SEPs). During these times, a person can enroll in or change health insurance coverage.
The various Medicare enrollment periods include the initial enrollment period, the general enrollment period, and the special enrollment period (SEP).
This article discusses what the SEP is, who might be eligible, and where a person can find more information.
What is a special enrollment period?
This article originally appeared on Medical News Today
After the initial enrollment period ends, a person may have the option to sign up for Medicare plans or change their plans during the SEP. During this time, a person can:
join a Medicare Advantage (Part C) plan, with or without drug coverage
join a Medicare prescription drug plan (Part D)
switch to another plan
If a person signs up or makes changes during this time, they will not need to pay a late enrollment fee.
Other enrollment periods
There are various enrollment periods:
Initial enrollment period: This begins 3 months before a person turns 65 years old and ends 3 months after they turn 65 years old.
General enrollment period: A person can apply for Medicare from January 1 through March 31 each year. However, penalties may apply.
A person can find out when they should enroll by answering questions on the Medicare website.
Eligibility
Eligibility to sign up during an SEP depends on various circumstances. Some examples include:
a person being affected by a natural disaster or emergency
an employer group healthcare plan ending or a person being enrolled in an alternative health plan
a person’s employment ending
an individual no longer qualifying for Medicaid
an individual moving to a new location or returning to the United States from abroad
a person getting released from prison
a plan changing its contract
a person being offered other coverage
In several other circumstances, a person may also be able to sign up for an SEP, such as being eligible for both Medicare and Medicaid or qualifying for Extra Help.
This online tool can help a person find out whether they qualify for an SEP.
Which situations do not qualify for a special enrollment period?
A person will not quality if:
Their COBRA coverage ends.
Their retiree coverage ends.
They lose or have Marketplace coverage.
They missed the 8-month period to sign up when they stopped working or lost job-based coverage.
They have end stage renal disease (ESRD).
A person will also not qualify if their income exceeds Medicaid limits or if the income increases beyond the state’s Medicaid eligibility threshold.
Learn more about ESRD and Medicare.
When can a person sign up or make changes during a special enrollment period?
Each SEP has different and separate rules regarding when a person can make changes or enroll in a new plan.
For example, if a person did not sign up for Medicare parts A or B when they were first able to do so because they had a group health plan insurance plan based on their current employment, the individual could sign up:
at any time they are still working and covered by the group health plan
within 8 months of the day the person or their spouse stops working
within 8 months of the day the health group plan ends while a person or their spouse carries on working
Some more examples are outlined in the table below:
Specific situation | How long to make changes |
|---|---|
moving back to the United States from abroad | 2 months after moving back to the United States |
being released from jail | 2 months after being released from jail, if a person kept paying for Part A and B coverage |
being no longer covered by Medicaid | 3 months after the date a person is no longer eligible or the date a person is notified that they are no longer eligible |
living in or having recently moved out of a living facility | for as long as a person lives in the facility and 2 months after the month they leave the facility |
leaving coverage offered by an employer or union | 2 months after the month after their coverage ends |
When will coverage begin?
This can vary. However, it typically begins on the first of the month after the plan receives a person’s request to enroll.
How can a person apply during a special enrollment period?
Depending on the situation, a person may first need to sign up for Medicare parts A and B. They can do so through the SSA.gov website.
They may also need to fill out various forms, such as Form CMS-10797 or Form CMS 40B, and send it to their local Social Security office via fax or email.
A person can find out more about their specific situation and their next steps here.
Contact information
If a person requires any help, they can call Medicare at 800-633-4227. Those who are hard of hearing can call 877-486-2048
Extra Help and special enrollment periods
Extra Help is an assistance program that helps people with limited income cover the cost of Medicare prescription drugs.
Individuals with Extra Help can sign up for Medicare Part D during SEPs, and a person can make changes to their coverage plans during:
January to March
April to June
July to September
If a person is eligible for Extra Help, certain SEPs cover these circumstances, including:
Situation | What can they do? |
|---|---|
A person is eligible for Medicare and Medicaid or has Extra Help. | They can switch, enroll in, or drop a Medicare prescription drug plan or Medicare Advantage plan. |
A person is enrolled in a state pharmaceutical assistance program (SPAP). | They can join a Medicare drug plan or Medicare Advantage plan with drug coverage. They can only do this once per calendar year. |
| They can join a Medicare drug plan or Medicare Advantage plan with drug coverage. A person can do this the month they lose SPAP eligibility or are notified of the loss of eligibility. |
Costs
When a person enrolls in an Advantage plan or Medicare parts B or D during an SEP, they do not pay a late enrollment penalty.
However, a person who enrolls outside the SEP may have to pay a penalty on the premium for as long as they have Medicare.
Summary
Each Medicare SEP has different rules about when a person can make changes to or enroll in a new plan.
Plans may include Original Medicare (Part A and Part B), a Medicare Advantage (Part C) plan, or a Medicare prescription drug plan (Part D).
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View the original article on Medical News Today
