Are you a Medicare beneficiary with a recent change in circumstance? If so, don't go anywhere! We're here with everything you need to know about Special Enrollment Periods for Medicare.
Medicare involves many different types of enrollment periods and Special Enrollment Periods apply to every part of Medicare. You're eligible for a Special Enrollment Period when you have a qualifying life event.
Depending on the type of life event that occurs, your Special Enrollment Period will come with its own rules and timeframe. We'll go over the most common ones next.
The most common qualifying event for Special Enrollment Periods is the loss of employer coverage. Many people continue to work past 65, so it isn't a surprise that this is the circumstance that happens most often. When you delay enrolling in Medicare under this circumstance, you're eligible for an eight-month Special Enrollment Period.
If you choose to delay Medicare while you continue to work past age 65, make sure your coverage is credible. To be creditable, the employer must have 20 or more employees. If your coverage isn't creditable and you delay enrollment, you'll be subject to a lifetime penalty on top of your Part B premium. This penalty goes up for every 12 months you delay. Your eight-month enrollment period begins when your group plan coverage ends.
The documents you'll need to enroll in Medicare when you previously had creditable group coverage are available 100% online. Most people enroll in Part A while they are still working (because it's premium-free). But you can later enroll in Part B and fill out and submit the form you need to do so, which you can obtain online. The form to prove that you had creditable coverage through your employer after becoming eligible for Medicare will need to be completed by both you and your employer.
Another qualifying event is relocation. Some circumstances that qualify you for a Special Enrollment Period for Medicare Advantage or Part D are: • Moving out of your plan's current service area • Entering or leaving a long-term care facility – this Special Enrollment Period lasts the duration of your stay at the institution plus two full months after you move out • Release from incarceration
Additionally, if Medicare fails to renew or terminates your Advantage or Part D plan, you're eligible for a Special Enrollment Period.
The next circumstance is becoming eligible for Extra Help with Part D. This Special Enrollment Period is only available during the first nine months of the year because the Annual Enrollment Period runs from October through December.
If a New Advantage or Part D plan with a five-star rating is available in your location, you'll get a Special Enrollment Period to enroll in the plan.
Less common qualifying events: • No longer eligible for Medicaid • Eligible for a Medicare Advantage Special Needs Plan • Losing another form of drug coverage
Now that you know about the different types of SEPs, here's how to be prepared: • Notify your carrier of the changes ahead of time if possible (can extend timeframe) • Know the window of opportunity you have for the SEP you qualify for • Have the forms you need ready • Shop around and become informed about plans
Thank you for taking the time to watch our video! We hope you found it educational. Please see the links below.
If you're a Medicare beneficiary and recently had a change in circumstance, don't go anywhere. In today's video, we're going to discuss everything you need to know about Special Enrollment periods. Hi Medicare Community. My name is Lindsay Malzone, and I'm the Medicare expert for Elite Insurance Partners and MedicareFAQ.com. Medicare comes with many different types of enrollment periods. Special Enrollment periods apply for every part of Medicare. You're eligible for a Special Enrollment period when a qualifying life event occurs for the specific individual. There are many different types of Special Enrollment periods. Each one comes with its own unique rules and time frame. Well go over the most common ones next. The most common qualifying event that can make a Medicare beneficiary eligible for a Special Enrollment period is due to loss of employer coverage. As many Medicare beneficiaries continue to work past the age of 65, you can understand why this Special Enrollment period is one of the most common. When a Medicare beneficiary delayed enrolling into Medicare due to having group employer coverage and they lose this or they lose it through their spouses employer. They become eligible for an eight-month SEP. It's important to make sure that your employer group coverage is considered creditable under Medicare. This is important because if it's not considered creditable and you delay coverage, you'll be paying a penalty for every 12 months you go without coverage. Group coverage is considered creditable as long as the employer has more than 20 employees. This eight month Special Enrollment period will begin once your group employer coverage has ended. Next, let's discuss what documents you'll need when using the Special Enrollment period due to loss of employer coverage. Whether you choose to enroll in Original Medicare when you first become eligible or you do so due to a qualifying events and being eligible for a Special Enrollment period, you can do so 100% online. Most beneficiaries choose to enroll in Part A regardless of having any group coverage. This is because for most its premium free. So, in order to enroll in Part B only during a Special Enrollment period, you'll need to complete two forms. You can either fax, mail, or drop them off at your local Social Security Office. You can also upload them online, through your Medicare dashboard. The first form, you'll need to have completed is CMS L564. This is known as request for employment information. This form will verify that you had another form of creditable coverage since you were first eligible for Medicare. This form is one that needs to be completed by your employer. The second form is CMS 40B. Application for enrollment in Medicare Part B. Another qualifying event that can make you eligible for a Special Enrollment period is relocation. The following are some circumstances when moving that qualify you for an SEP to enroll in either a Medicare Advantage or Part D plan. The first one is if you move out of your plan service area. Since some Medicare Advantage, plans are specific to a specific location, if your current plan is not available at your new location, then you can switch to a plan that is available. When you either enter or leave a long-term care facility or nursing home. This is a qualifying event that will make you eligible for a Special Enrollment Period. This will allow you to either join, switch, or drop your coverage. The timeframe of this SEP will last the duration of your stay at the institution plus, 2 full months after you move out. Another qualifying event that can make you eligible for an SEP is when you're released from incarceration. Another change in circumstance that can make you eligible for an SEP is if your plans contract changes. If Medicare does not renew or terminates your Medicare Advantage or Part D plan, then you'll be eligible at that time to change to a new one. The next qualifying event for an SEP is if you're eligible for extra help for Part D. If you become eligible for extra help, which is a program that helps you pay for prescription drugs, then you'll be entitled to an SEP that will allow you to make changes to your current prescription drug coverage. This Special Enrollment period is only available during the first 9 months of the year. This is because the Annual Enrollment period that begins in October will also allow you to make changes. Another qualifying event that would make you eligible for an SEP is if a new Medicare Advantage or Part D plan with a five star rating becomes available in your area. If a new five-star plan is introduced to your area, you'll be eligible to enroll. Next, we'll go over less common qualifying events that can make you eligible for a Special Enrollment period. You'll be eligible for an SEP if you're no longer eligible for Medicaid. At this time, you'll have 3 full months to join, switch, or drop a Part D or Medicare Advantage plan. Another qualifying event is if you become eligible for Medicare Advantage special needs plan due to conditions such as cancer, dementia, or chronic heart failure. If you're diagnosed with one of these conditions, then you'll have a Special Enrollment period to enroll a special needs plan. If you had another form of creditable drug coverage and you lose it. You'll have 2 months to enroll in either a Medicare Advantage plan with drug coverage or an individual Part D plan. Now that you know about the different types of Special Enrollment periods you can be eligible for, let's go over how you can be prepared. Make sure to notify your Medicare Advantage or Part D carrier of these changes ahead of time if you can. This may offer the opportunity to extend the time frame. For example, if you qualify for an SEP due to moving, you normally will get 2 full months to change your plans. However, if you notify your carrier ahead of time you'll have extra time to make the change before you move. Make sure to know the window of opportunity you have for the Special Enrollment period you qualify for. Each one has its own time frame. Make sure to have the necessary forms ready, such as the 2 forms needed due to dropping employer coverage. Make sure you shop around and do some research on all the different plans that are available in your area to make the best educated decision. This is where license agent can help. Thank you for taking the time to watch our video. We hope you found it educational. And if you aren't already, make sure to subscribe to our YouTube channel. Notifications need to be turned on so you're notified each time we upload a new video. We also have a great community on Facebook. Well make sure to include a link in the description below so you can join. Until next time. Bye.