Medicare Special Enrollment Periods allow you to make changes to your Medicare elections or delay Medicare coverage without penalty or medical underwriting. Below, you will find the details you need to know about Special Enrollment Periods for Medicare.

Medicare Special Enrollment Periods

When using Medicare Special Enrollment Periods, beneficiaries can enroll in Medicare outside of typical Medicare enrollment periods. Because of this, beneficiaries may delay original Medicare enrollment due to creditable coverage or change current Medicare benefits due to a qualifying life event.

Medicare beneficiaries who experience a qualifying life event get a two-month Special Enrollment Period.

Qualifying life events include:

  • Moving out of your plan’s service area
  • Moving back to the U.S. after living abroad
  • Release from incarceration
  • Gaining or losing eligibility for a Special Needs Plan
  • Enroll in or leaving the Program of All-Inclusive Care for Elderly (PACE)
  • Your plan stops providing coverage in your area
  • You want to enroll in a 5-star plan
  • You gain or lose eligibility for Medicaid, Extra Help, or a Medicare Savings plan
  • You move into or out of an institutional facility
  • You gain or lose eligibility for a qualified State Pharmaceutical Assistance Program

Those who are still working and choose to delay Medicare benefits due to qualifying creditable coverage get an eight-month Special Enrollment Period. During this time, they can enroll in Original Medicare and can then enroll in a Medicare Supplement plan or Medicare Advantage plan.

When using your Special Enrollment Period to enroll in Medicare Part A, Part B, and Part D, you will not be subject to any penalties. Keep in mind, you only have two months to enroll in a Part D plan while using a Special Enrollment Period.

There is no road map telling you when to apply for Medicare. However, if you understand enrollment periods and know when you are eligible for a Special Enrollment Period, you can avoid an unnecessary lapse in coverage or a potential penalty.

Medicare Part B Special Enrollment Period

If you work past age 65 and remain on creditable employer group coverage, you qualify for an eight-month Special Enrollment Period beginning on the date you lose the creditable coverage. During this SEP, you can choose to enroll in Medicare Part B, as well as a Medicare Supplement or Medicare Advantage Plan without penalty.

It is important to enroll in the a plan as soon as you are eligible. If you delay enrollment past the eight-month mark, you will be subject to late enrollment penalties that can last as long as you have Medicare coverage.

Medicare Part A Special Enrollment Period

Because most Medicare-eligible individuals enroll in Medicare Part A as soon as they can, the Medicare Part A Special Enrollment Period is not as common as its Part B counterpart. However, if you delay Medicare Part A enrollment you could qualify for a Special Enrollment Period.

To qualify for a Special Enrollment Period, you must have delayed Medicare Part A due to creditable health coverage. Creditable health coverage is typically provided by an employer. You will have eight months after losing coverage to elect Medicare Part A benefits. If you do not enroll before the eight-month window is over, you will be assessed the Medicare Part A penalty when you do elect coverage.

Medicare Part D Special Enrollment Period

Medicare Part D is no exception when it comes to providing Special Enrollment Periods. If you delay Medicare Part D coverage, you will receive a two-month Special Enrollment Period when you lose your creditable drug coverage.

During this Special Enrollment Period, you can enroll in any Medicare Part D plan you wish. Coverage will begin on the first day of the following month.

Trial Right Special Enrollment Periods

Medicare also offers two trial rights that allow you to use a Special Enrollment Period to enroll in a Medigap plan if you are not happy with the Medicare Advantage plan you originally chose.

The first trial right allows you to switch back to Original Medicare within the first 12 months of enrolling in a Medicare Advantage plan at age 65. You will be able to enroll in a Medicare Supplement plan using a Special Enrollment Period.

The second trial right allows anyone who switched from a Medicare Supplement plan to a Medicare Advantage plan for the first time to drop Medicare Advantage and return to their Medigap plan within the first 12 months.

Both trial rights allow the use of Special Enrollment Periods to change from Medicare Advantage to Original Medicare coverage with a Medicare Supplement plan.

How To Use Special Enrollment Periods

When you are eligible for a Special Enrollment Period, it is best to act quickly. Although you may have two to eight months to enroll in a new plan, it is important to not lose track of time and let your Special Enrollment Period slip by.

When enrolling in a plan, be sure to discuss your Special Enrollment Period options with your licensed agent first. This will help to ensure all information is recorded during the application process.

Sources:

  1. Special Circumstances (Special Enrollment Periods), Medicare.gov. Accessed February 2022.
    https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
  2. Medicare’s Special Enrollment Periods (SEP), National Council on Aging. Accessed February 2022.
    https://www.ncoa.org/article/medicare-s-special-enrollment-periods-sep
  3. Special Enrollment Period (SEP). SSA.gov. Accessed February 2022.
    https://www.ssa.gov/help/iClaim_medSEP.html

Jagger Esch

Medicare Expert

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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