Who Qualifies For A Special Enrollment Period?

There are two ways to qualify for a special enrollment period (SEP)—through retirement or a specific special circumstance. Let’s break down what a SEP is and how to qualify.

What is Medicare Special Enrollment?

In short, a special enrollment period is an opportunity to get the Medicare coverage you need without age or health considerations, late penalties, and without having to wait till the next open enrollment period.

If you don’t enroll in Original Medicare when you’re first eligible, you’ll likely accrue late fees if you don’t qualify for a SEP. For other Medicare plans like Part C or Part D, you have to wait until the general enrollment period (GEP) from January 1st through March 31st. Or, more likely, you’ll have to use the annual enrollment period (AEP) from October 15th through December 7th. The best time to enroll (if you’re eligible) is a SEP.

Special Enrollment with Retirement

The best time to enroll in Medicare is when you first become eligible at age 65. If you miss that opportunity, you may have late fees—but the best way to avoid late fees is with a SEP.

If you are not yet retired when you turn 65, you can wait to enroll in Medicare till you retire. Once you retire, you’ll be eligible for a 6-month special enrollment period without late penalties or health considerations.

Other Special Enrollment Circumstances

There are many other instances where you have to make quick changes to your Medicare coverage apart from enrolling for the first time. There are, then, lots of ways to qualify for special enrollment, including, but not limited to:

  • Moving outside of your plan’s service area or to an area with new plan options
  • Moved back to the U.S. (you must be a U.S. citizen to receive Medicare)
  • Moved in or out of an institution like a nursing home or prison
  • You’re no longer eligible for Medicaid
  • You left your employer coverage (see section on retirement)
  • You lose prescription drug coverage
  • You lost your PACE coverage
  • You have a chance to get different coverage
  • Your plan changes its contract
  • You’re eligible for both Medicare and Medicaid
  • You qualify for Part D Extra Help
  • You had a Special Needs Plan (SNP) and no longer qualify

Working Towards Your Future—Call the Medicare Sharks

There are plenty of ways to plan your Medicare enrollment and beyond with the Medicare Sharks. We’ll make sure you have options to understand your best coverage. To learn more, call us at 561-225-3022 or 561-225-3633.