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Using Medicare’s Special Enrollment Period

Written by Evens Stevenson

Keeping all of Medicare’s enrollment periods straight can be a confusing process. There are so many different dates, rules, and regulations, and it’s very easy to get some of them confused. But, missing some dates can lead to serious fees or penalties. 

One of the biggest penalties you could face is missing your initial Medicare enrollment date. For every year that you delay enrolling in Medicare Part B, without falling under Medicare Special Enrollment Periodone exceptions, you will face a 10% increase on your monthly premiums. It’s easy to see why it’s so important to enroll on time. There are several different scenarios that you are allowed to delay enrolling without having to pay penalties.

For those individuals who have delayed moving forward with their Medicare Part B enrollment beyond age 65 due to current employment – either their own or their spouse’s – there is a way to enroll in Medicare through a Special Enrollment Period, or SEP. In doing so, you will typically be able to avoid the premium penalty that you would otherwise be liable for due to a late enrollment in Medicare for other, non-excused reasons.

When is the Special Enrollment Period for Medicare Part B Coverage?

There are actually two different time periods in which a person can enroll in Medicare Part B through a Special Enrollment Period (SEP). An individual can use his or her Special Enrollment Period at either of the following times:

  • At any time while they or their spouse is still working – between the end of their Initial Enrollment Period at age 65 and the time when they or their spouse stops working or loses their employer sponsored health coverage
  • For up to 8 months after this employment or coverage has ended

In other words, the deadline for enrollment in Medicare Part B coverage without incurring a premium penalty in this particular situation would be the end of the eighth month after the individual’s (or their spouse’s) employment has ended.

When Will Medicare Part B Coverage Begin?

When enrolling in Medicare Part B coverage during a Special Enrollment Period, an individual’s coverage will begin on the first day of the month after the person enrolls. This will occur regardless of whether they are still covered by their employer health benefits or are in that 8-month grace period.

During this same period of time, if the individual has not already done so, he or she can also sign up for Medicare Part A coverage, along with Part D coverage. Or, alternatively, the individual can opt to enroll in a Medicare Advantage plan.

What About Medicare Supplement Insurance?

If the individual does move forward and enroll in Medicare Part B, he or she will be considered to be enrolled in “Original Medicare,” which consists of Medicare Part A and Part B. Because of this, the person will also be eligible to apply for a Medicare Supplement Insurance Plan.

When applying for Medicare Supplement Insurance during your open or initial enrollment period,  federal law prohibits Medicare Supplement insurance companies from denying coverage or charging more for coverage due to pre-existing health conditions.

Therefore, this constitutes a good time to also apply for Medicare Supplement coverage. If a person waits until after this time period expires to apply for Medicare Supplement, they will run the risk of being charged a higher premium amount, or of being turned down for coverage altogether if they have a health issue.

Medicare Part D Special Enrollment

In addition to Medicare Part B, Medicare Part D also offers Special Enrollment Periods for the Medicare prescription drug plans. This means that you could be eligible to join a Medicare Part D plan – or to switch to a different plan – in certain qualifying situations, outside of the Open Enrollment Period.

Some of these situations include the following:

  • If you are not adequately informed about creditable prescription drug coverage. Individuals who were not adequately informed of the creditable status of drug coverage provided by an entity required to give such notice or who were not adequately informed of a loss of creditable coverage are eligible to enroll or switch to a different Medicare Part D plan. This one-time Special Enrollment Period is, however, typically only granted on a case by case basis, and it usually only permits one enrollment or dis-enrollment.
  • Involuntary loss of creditable coverage. Those who involuntarily lose creditable coverage – including a reduction in the level of coverage so that it is no longer creditable – may also be eligible to select a new plan.
  • Error by a Federal employee. Individuals whose enrollment or non-enrollment in a Medicare Advantage and / or a Medicare Part D plan is erroneous due to an action, inaction, or an error by a Federal employee will also be eligible to make a change via a Special Enrollment Period. This, too, is typically a one-time only event that is granted on a case by basis, and permits one enrollment or dis-enrollment.

Medigap Open Enrollment

There is one more enrollment date that you should be aware of, and that’s your Medigap Open Enrollment period. It doesn’t fall under a Special Enrollment Period, but missing it could cost you thousands of dollars. Needing more coverage than original Medicare provides, try enrolling into a Medicare Supplemental Insurance policy. The most comprehensive of the Medigap plans is Medigap Plan F.

You can apply for one of these policies at any time about your turn 65 and enroll in Part B, but your Medigap Open Enrollment period is the best time. This open enrollment period starts the month that you turn 65 and enroll into Part B Medicare, and lasts for six months. During this six-month window, the insurance companies can’t decline your application, regardless of your health or pre-existing conditions. Additionally, not only do they have to approve you for your coverage, but they also can’t charge you any more for your Medigap plan because of your health.

Our agents are standing by and will be glad to clear up any confusion and ensure that ensure that you get the health care quotes and coverage that fits your budget.

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