Do You Qualify for a Medicare Special Enrollment Period?

If you did not enroll in Medicare when you turned 65, there is a good chance that you could be eligible for a Special Enrollment Period. You might also be able to use a SEP to change your current plans. Today, we’re going to review when utilizing a Special Enrollment Period could be beneficial to you.

If you have a qualifying life event, you may be eligible for a Medicare Special Enrollment Period which allows you to sign up for a Medicare health plan outside of Open Enrollment.


What is a Special Enrollment Period?

 To be approved for a SEP, you must have had a qualifying life event. Depending on the situation, your SEP could last approximately 30 - 60 days. In addition, the kind of changes you can make may be limited in certain situations. You may have to provide proof of the event when you submit your application for a new plan.

 There’s quite a list of events that could make you eligible for a SEP, but we’ll review the common ones today.

Initial Medicare Enrollment

 Probably the most common situation a SEP is used for is when an individual postpones their enrollment into the Medicare program. Many people are continuing to work past the age of 65, which is when you officially “age into” Medicare. However, if you have an employer-sponsored plan, many people choose to stay on that plan rather than transitioning to Medicare. As long as that group health plan is credible, you can do so without penalty.

When they do decide to retire and lose their group coverage, they will qualify for a Special Enrollment Period, when they can enroll in Medicare Parts A and B and any other supplemental insurance plans they choose. This would include a Medicare supplement (Medigap), Medicare Advantage plan, and a Part D prescription drug plan.

Other Eligible Situations

 Other life events that might qualify you for a SEP include:

  • If you move to a new city, state, or zip code
  • If you move into or out of an institution, like a skilled nursing facility
  • If you gain or lose Medicaid eligibility
  • If your current plan leaves the area
  • If your current plan becomes insolvent
  • If your current insurance carrier breaks Medicare rules
  • If you are diagnosed with a chronic condition
  • You choose Medicare Advantage for the first time and want to move back to Original Medicare within the first 12 months of having the plan

 This is not a complete list of qualifying events. If you have had any life changes, you should speak with one of our licensed insurance agents to find out if you might qualify for a Special Enrollment Period. We will help you determine if you’re eligible to change your current plan and will also help you find a new plan that fits your needs.

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