You know there’s an open enrollment period for Medicare sign-ups every year — but what if you find yourself in extenuating circumstances and need to sign up before or after?

If you are going through a major change, such as a change in residence, retiring from work or loss of employer-sponsored benefits through a spouse—you could have an opportunity to enroll into a new Medicare insurance plan outside of the normal enrollment periods. Medicare officially has 18 “Special Enrollment Periods” (SEP) during which you can sign up for Medicare outside the standard “Open Enrollment Period”.  Read below for detail on the most common Special Enrollment Period scenarios.

Medicare Part A & B

After your Initial Enrollment Period is over, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or if you’re disabled, a family member’s), you can sign up for Part A and/or Part B:
■ Anytime you’re still covered by the group health plan
■ During the 8-month period that begins the month after the
employment ends or the coverage ends, whichever happens first

Medicare Advantage

In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples are:

■ You move out of your plan’s service area
■ You are losing employee benefits or COBRA
■ You have Medicaid or within six months of losing it
■ You get Extra Help/Low Income Subsidy
■ You live in an institution, like a nursing home
■ Switch to a Medicare Advantage Plan with 5-star rating

Medicare Supplement

If you have Original Medicare (Part A & B only) or you are an existing Medicare Supplement policyholder, you are allowed to sign up for a new supplement plan ANYTIME throughout the year.

Loss of Employee Coverage/Retiring

When you turn 65, you may join or drop employer/union health and/or drug coverage regardless of whether it is creditable. Employer coverage may be current or former (retiree plan).

You have an SEP if…

You choose to:

  • enroll in or disenroll from a employer/union-sponsored Medicare Advantage Plan or Part D plan
  • disenroll from a Medicare Advantage Plan or Part D plan to take employer/union-sponsored coverage.
  • disenroll from employer/union-sponsored coverage of any kind (including COBRA3) to enroll in a Medicare Advantage Plan or Part D plan.

Your SEP lasts…

  • Your SEP to join or disenroll from a Medicare Advantage Plan or Part D plan, or to switch Medicare Advantage Plans or Part D plans is available to persons who have or are enrolling in an employer plan and ends two months after the month in which your employer or union coverage ends.

Your coverage begins…

  • Up to three months after the month in which you submit a completed enrollment application.
  • If your employer/union was late sending in the application, your coverage may begin retroactive to when you submitted the application.

In short, if you are over 65 and losing employer coverage, or you are covered under your spouse’s employer plan and losing coverage, you are eligible for Medicare without penalties if you were on a “Credible Employer Health Plan” (usually a business with over 20 employees).

If you are eligible for premium-free Part A you can enroll in Part A at any time after you are first eligible for Medicare (65).

If you are eligible for Medicare Part B you have 8 months to sign up for Part B without penalty.

There are several variations of these rules, and it is best to consult with a licensed agent specializing in Medicare health care options like SeniorQuote to determine the best options for your particular circumstances.

 

Change in Residence

If you are moving to a new zip code, and your current plan is not offered in the new zip code, you have a Special Election Period.

You have an SEP if…

  • You move, permanently. You will have an SEP if you move out of your Medicare Advantage Plan’s or Part D plan’s service area or if you move to an area covered by your plan but more plans are available to you in your new coverage area.
  • You become eligible to enroll in a Part D plan or a Medicare Advantage Plan
    because you have:

    • Moved back to the U.S. after living abroad
    • You were released from prison (You aren’t eligible to enroll in Part D plans or Medicare Advantage Plans if you live outside the U.S. or are in prison.)

Your SEP lasts…

  • If you notify your Medicare Advantage Plan or Part D plan of a permanent move in advance, you have an SEP to switch to another Medicare Advantage or Part D plan beginning as early as the month before your move and lasting up to two months after the move.
  • If you notify your Medicare Advantage or Part D plan of a permanent move after you move, you have an SEP to switch to another private health or drug plan, beginning the month you tell your plan, plus two more full months thereafter. If you did not notify your private health or drug plan about a move:
    • and your Medicare Part D plan learns from CMS or the post office that you moved over twelve months
      ago, the plan should disenroll you twelve months after your move. Your SEP to switch to another Part D plan begins at the beginning of the twelfth month and continues
      through the end of the fourteenth month after your move.
    • and your Medicare Advantage Plan learns from CMS or the post office that you moved over six months ago, the plan should disenroll you twelve months after your move. Your SEP to switch to another Medicare Advantage Plan begins at the beginning of the sixth month and continues through the end of the eighth month after your move.
  • You qualify for an SEP to enroll in a Part D plan or a Medicare Advantage Plan. You have an SEP to join a Medicare Advantage or Part D plan beginning as early as the month before your move and lasting up to two months after the move.

Your coverage begins…

  • You may choose to begin coverage any time between the first day of the month you moved (as long as you have submitted a completed application), and up to three months after your Medicare Advantage Plan or Part D plan receives the completed enrollment application.
  • You may choose to begin coverage any time between the first day of the month you moved (as long as you have submitted a completed application), and up to three months after your Medicare Advantage Plan or Part D plan receives the completed enrollment application.

Here are the important issues for timing:

1. If you tell your plan before you move, your chance to switch plans begins the month before you move and continues for 2 full months after you move.

2. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan , plus 2 more full months.