Medicare Special Enrollment Periods (SEPs)

TMA

Exploring the 3 Ways You May Qualify

Medicare offers Special Enrollment Periods (SEPs) that allow individuals to enroll in or switch Medicare plans outside of the standard enrollment periods. These SEPs are crucial for individuals who experience certain life events or qualify for specific circumstances. Let’s explore what qualifies you for a SEP and how you can take advantage of them.

Qualifying for a Special Enrollment Period

There are three main reasons why you may qualify for a Special Enrollment Period:

  1. Qualifying Life Events (QLEs): If you experience a QLE, such as moving to a new area, losing health coverage, or other life-changing events, you may be eligible for a SEP.
  2. 5-Star Special Enrollment Period: Medicare rates plans on a scale of 1 to 5 stars, with 5 stars being the highest rating. If a 5-star plan becomes available in your area, you can switch to it during a SEP.
  3. Working Past Age 65: If you delayed enrolling in Medicare because you had employer-based coverage, you have an 8-month SEP to enroll in Medicare once that coverage ends.

Qualifying Life Events and Special Enrollment Periods

If you have Medicare and experience a QLE, you may qualify for a SEP to change your Medicare Advantage or Prescription Drug Plan. These events include:

  • Changing your primary residence
  • Losing your health insurance
  • Being eligible for other health insurance

*Each QLE has a specific timeframe within which you must act to qualify for a SEP. For example, if you move, your SEP is typically 60 days after your move.

5-Star Medicare Special Enrollment Period

If a 5-star Medicare plan becomes available in your area, you can switch to it during the 5-star SEP, which runs from December 8 to November 30 of the following year. It’s important to compare plans to ensure the new plan meets your needs.

Enrollment in Medicaid or Extra Help

Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:

  • January – March
  • April – June
  • July – September

If you lose benefits from Medicaid or Extra Help, you will have a one-time opportunity to adjust your Medicare Advantage enrollment.

Disenrollment from your initial Medicare Advantage plan

If you initially enrolled in a Medicare Advantage plan upon becoming eligible for Medicare, you have a 12-month window to disenroll from the plan and return to Original Medicare.

If you previously dropped a Medicare Supplement Insurance plan to join a Medicare Advantage plan but now want to switch back, you also have a 12-month period to do so (as long as this was your first enrollment in a Medicare Advantage plan).

Working Past Age 65 and the Special Enrollment Period for Medicare Part B

If you or your spouse work past the age of 65 and delay enrolling in Medicare, you have an 8-month SEP to enroll in Medicare Part B once you retire or lose employer coverage. This helps you avoid late penalties.

Avoiding Gaps in Coverage and Part D Late Enrollment Penalties

To avoid gaps in coverage, enroll in Medicare before you lose employer-based coverage. If you anticipate retiring, contact your employer’s human resources department one or two months in advance to time your Medicare enrollment correctly.

Understanding Medicare Special Enrollment Periods is crucial for individuals to make informed decisions about their healthcare coverage. Whether you’re experiencing a QLE, have access to a 5-star plan, or are working past age 65, knowing your options and timing is key to maximizing your Medicare benefits.

If you would like more information on the SEP, or to find out if you may qualify, please contact our office today and we would be happy to assist you.

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