Special Enrollment Period (SEP)
The Special Enrollment Period (SEP) allows individuals who meet specific criteria to sign up for Medicare outside other enrollment periods.
SEP may also allow individuals to enroll or change a Medicare plan.
Who uses this special enrollment period?
Individuals who had employer group health coverage (EGHC) when they became Medicare-eligible at age 65, and opted to continue EGHC, may have delayed enrolling in Part B.
When their EGHC ends, they may use this period to enroll in Part B and to do so without incurring a penalty.
Individuals who have EGHC, and an Health Savings Account, to which they want to continue to contribut, may delay both Part A and B until EGHC terminates and they stop contributing to the HSA.
What situations allow for SEP?
A commong situation that allows for a special enrollment period are individuals who delay signing up for Medicare Part B at age 65 because they continue to work and have employer group health coverage.
There are situations that may allow an individual to enroll or change their Medicare Advantage or Prescription Drug Plan.
Some situations are:
- Moving out of the plan’s service area
- Admission into a skilled nursing facility
- Qualifying for a chronic needs plan
- Qualifying for Medicare & Medicaid, dual-eligible plan
- Opting to enroll in a 5-Star plan
Other exceptional situations for a special enrollment period are those impacted by a natural disaster, incarceration, employer or health plan error, losing Medicaid coverage, or other circumstances outside of the enrollee’s control that Medicare determines to be exceptional.
To learn more, you can Call Medicare, visit the Medicare website, or Contact Jean Enyeart.
What is the 5-Star Rating SEP?
At any time during the year, a Medicare enrollee, already enrolled in a Medicare Advantage Plan (Part C) or a stand-alone prescription drug plan (Part D), may change to a 5 star-rated plan. But, only to a 5 star-rated plan.
The change must be a like plan change. This means changing from a Part C plan to another Part C plan, or changing from a Part D plan to another Part D plan.
How long does this period last?
The lenght of Special Enrollment Period may vary depending on the situation.
It is best to seek professional advice.
Why use this period for Part A or B?
Individuals who had employer group health coverage (EGHC) when they became Medicare-eligible at age 65, and opted to continue EGHC, may have delayed enrolling in Part B.
When their EGHC ends, they may use this period to enroll in Part B and to do so without incurring a penalty.
Individuals who have EGHC, and an Health Savings Account, to which they want to continue to contribut, may delay both Part A and B until EGHC terminates and they stop contributing to the HSA.
What situations allow for SEP?
A commong situation that allows for a special enrollment period are individuals who delay signing up for Medicare Part B at age 65 because they continue to work and have employer group health coverage.
There are situations that may allow an individual to enroll or change their Medicare Advantage or Prescription Drug Plan.
Some situations are:
- Moving out of the plan’s service area
- Admission into a skilled nursing facility
- Qualifying for a chronic needs plan
- Qualifying for Medicare & Medicaid, dual-eligible plan
- Opting to enroll in a 5-Star plan
Other exceptional situations for a special enrollment period are those impacted by a natural disaster, incarceration, employer or health plan error, losing Medicaid coverage, or other circumstances outside of the enrollee’s control that Medicare determines to be exceptional.
To learn more, you can Call Medicare, visit the Medicare website, or Contact Jean Enyeart.
What is the 5-Star Rating SEP?
At any time during the year, a Medicare enrollee, already enrolled in a Medicare Advantage Plan (Part C) or a stand-alone prescription drug plan (Part D), may change to a 5 star-rated plan. But, only to a 5 star-rated plan.
The change must be a like plan change. This means changing from a Part C plan to another Part C plan, or changing from a Part D plan to another Part D plan.
How long does this period last?
The lenght of Special Enrollment Period may vary depending on the situation.
It is best to seek professional advice.