Many Medicare beneficiaries will sign up for coverage when they first become eligible for Medicare benefits, during their Initial Enrollment Period.
A Special Enrollment Period (SEP) is an enrollment period that takes place outside of the annual Medicare enrollment periods. They are granted to people who were prevented from enrolling in Medicare during the regular enrollment period for a number of specific reasons.
Special Enrollment Periods exist for Original Medicare (Part A and Part B), as well as for Medicare Advantage (Medicare Part C) and prescription drug plans (Medicare Part D).
There are a few scenarios that may qualify someone for a Special Enrollment for Original Medicare.
Some of these qualifications include:
If you did not enroll in Medicare when you turned 65 because you were still employed and were covered by your employer’s health insurance plan, you will be granted a Special Enrollment Period. This allows you to enroll in Medicare once you leave your employer coverage, even if you work past the age of 65, the qualifying age for Medicare.
Beginning the month that follows the end of your employer coverage (whether you retired or your coverage was terminated), you will be given a Special Enrollment Period of eight months to sign up for Part A and/or Part B.
One thing to note: Medicare does not consider COBRA coverage or retiree health plans to be active employer coverage. If you did not enroll in Medicare when you turned 65 because you were covered by COBRA insurance or a retiree health insurance plan, you will not be granted a Special Enrollment Period. You may be subject to late enrollment penalties if and when you do sign up for Medicare.
If you failed to enroll in Medicare when you first became eligible because you were participating in volunteer work in another country, you may also be granted a Special Enrollment Period. In order to qualify, you must have:
TRICARE beneficiaries who are under 65 and qualify for Medicare because of a disability, ALS (Lou Gehrig’s Disease) or End-Stage Renal Disease (ESRD) may be eligible for a Special Enrollment Period if they didn’t sign up for Medicare Part B when they first became eligible.
The beginning and end dates of your Special Enrollment Period will differ from one qualifying scenario to the next.
You may want to explore some additional qualifying Medicare Special Enrollment Period scenarios.
If you have a particular situation that prevented you from enrolling in any type of Medicare coverage for which you were eligible, you are encouraged to call 1-800-MEDICARE and request a Special Enrollment Period.
You can sign up for Original Medicare one of four ways:
Many Medicare beneficiaries enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan during the Medicare Fall Open Enrollment Period.
If you don’t enroll in a Medicare plan during this annual period, you may qualify for a Special Enrollment Period.
There are many ways to qualify for a Medicare Advantage Special Enrollment Period or a Medicare Part D Special Enrollment Period.
Some of the situations that may qualify you for one of these types of Special Enrollment Periods include:
The above list does not necessarily include every and all qualifications for a Special Enrollment Period.
If you are unsure about whether you qualify for a Medicare Special Enrollment Period, or if you qualify and want to compare plans in your area, you can speak with a licensed insurance agent for help.
A licensed insurance agent can answer any questions you have and help you compare benefits, costs, coverage and other details of Medicare Advantage plans that may be available in your area.
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