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Medicare Special Enrollment Period
Medicare Special Enrollment Period: Due to extenuating circumstances, you may be able to enroll in Medicare outside of the standard enrollment periods. This is referred to as the Medicare Special Enrollment Period (Medigap) (SEP). You can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP) if you qualify for the Medicare Special Enrollment Period (GEP).
For Medicare Advantage and Medicare prescription medication plans, there are additionally Special Election Periods (also known as Special Enrollment Periods).
Special Enrollment Period for Original Medicare
Delaying Medicare Part B enrollment
One scenario that some people are familiar with is that they are still working at 65 – or that their spouse is still working. If you’re insured by a group health plan through your employer, you might want to wait until your other health coverage expires before enrolling in Medicare Part B. Part B includes a premium and often provides coverage that is quite similar to that of a group health plan.
If you are 65 or older and have a group health plan, you will typically have a Special Enrollment Period during which you can enroll in Medicare Part B. This implies you can put off enrolling in Medicare Part B until later without incurring the 10% monthly premium penalty for late enrollment.
Delaying Medicare Part A enrollment
If you’ve worked for at least 10 years (40 quarters) and paid Medicare taxes, you’ll be eligible for Medicare Part A without paying a premium. If you don’t have enough work history to qualify for premium-free Medicare Part A and want to wait until you reach 65 to join because you have employer-sponsored coverage, you can sign up for Part A during your Special Enrollment Period. If you don’t enroll when you’re first eligible and need to pay a premium, you may face a late-enrollment penalty for Medicare Part A.
In such cases, you have the option to:
- Enroll in Medicare Part A and/or Part B at any time while you’re covered by your existing employer’s group health plan.
- Enroll in Medicare Parts A and B within the eight-month period beginning with the month your group health coverage finishes or your work ends, whichever comes first. If your work or employer-provided group health plan coverage ceases during your Initial Enrollment Period, the Medicare Special Enrollment Period restrictions do not apply.
You will have to wait until the next General Enrollment Period, which begins January 1 of the following year, if you do not enroll in Medicare by the conclusion of the eight-month period. You may also have to pay a higher Medicare Part B premium. You may owe a late-enrollment penalty for Part A if you don’t qualify for premium-free Medicare Part A.
A Medicare Special Enrollment Period applies to people who receive Social Security disability payments and are insured by a group health plan through their own or a family member’s current job. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week for further information on situations that may qualify you for a Special Enrollment Period; TTY users can call 1-877-486-2048.
Special Election (Enrollment) Period for Medicare Advantage and Medicare prescription drug plans
The Special Election Period (SEP), also known as the Special Enrollment Period (SEP), for Medicare Advantage and prescription medication programs differs from the SEP for Original Medicare.
Those who have lost their Medicare Advantage/prescription drug coverage are usually eligible for the SEP. You might be eligible if your plan discontinued taking Medicare or moved out of your area, or if you moved out of the plan’s service area.
If your neighborhood is affected by a natural disaster, you might be eligible for a Medicare Advantage/prescription drug SEP. There are a few limitations to this SEP that you should be aware of. All of the following must apply to you:
- Your county has been declared an emergency or catastrophic catastrophe by the Federal Emergency Management Agency (FEMA).
- You were a resident of the affected county when FEMA declared a major disaster or declared an emergency.
- When FEMA declared an emergency or catastrophic catastrophe, you were in the middle of a legal election period.
- When the emergency or significant catastrophe was proclaimed, you hadn’t yet modified your coverage.
- The SEP for your scenario is still valid.
The first day of the month in which you are at least 65 and have Medicare Parts A and B begins your Medicare Supplement Open Enrollment Period (OEP). When the firm is required to sell you a Medicare Supplement insurance plan, you have six months to purchase it. If you wait until after your Medigap OEP, you can apply at any time, but if you have health problems, a plan may reject you or charge you more.
After your Medigap OEP, you may have “guaranteed-issue rights” to a Medicare Supplement Insurance plan at later periods.
Let’s imagine you decide to enroll in a Medicare Advantage plan. (Medicare Supplement Insurance policies are not compatible with Medicare Advantage plans.)
- Let’s say you decide to cancel your Medicare Advantage coverage and go back to Original Medicare.
- Assume you’ve been enrolled in a Medicare Advantage plan for a year or fewer.
- You have the option of purchasing a Medicare Supplement (Medigap) coverage.
- Only certain Medigap plans are covered by your “guaranteed issue rights.”
Medicare Supplement coverage of pre-existing conditions
The insurance provider cannot refuse to sell you a Medicare Supplement Insurance plan if you purchase it during the six-month Medicare Supplement Open Enrollment Period. The insurance provider also can’t charge you more or make you wait for basic benefits to start because you have health difficulties.
However, the Medicare Supplement policy’s benefits may not cover your pre-existing condition for up to six months.
A private insurance firm may “underwrite” a Medicare Supplement insurance plan if you apply for it outside of the Medicare Supplement Open Enrollment Period.
Underwriting the plan entails a physical examination, and the insurance company has the option of refusing to sell you the plan or adjusting your premium based on your health status.
How insurance companies set Medigap premiums
An insurance firm can establish Medigap premium rates for Medicare Supplement Insurance policies in one of three ways:
- Premiums for “community-rated” (or “no-age-rated”) policies are the same regardless of age.
- Premiums for “issue-age-rated” (or “entry-age-rated”) policies are calculated based on your age at the time of purchase. The sooner you purchase, the lower your price will be.
- Premiums that are “attained-age-rated” are calculated based on your current age and increase as you get older.
Inflation, geography, medical underwriting (if you didn’t buy a plan when you initially became eligible), and other discounts can all affect the premium costs for Medicare Supplement Insurance plans.
Before you buy, check with each individual health insurance to discover how they establish Medigap pricing.
*Pre-existing conditions are medical conditions that existed before the policy began. They may limit coverage, exclude you from coverage, or even prohibit you from being approved for a policy; however, each plan’s exact definition and applicable limitations or exclusions of coverage will vary, so read the official plan documentation to see how that plan handles pre-existing conditions.
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