Medicare Special Enrollment Period

checkmark Fact checked Reviewed by: Leron Moore, Medicare consultant - Updated: Jul 06, 2021

 

Medicare enrollment varies depending on an individual’s situation. Because not everyone is ready to retire by age 65, there is a special enrollment period for people who do not fall into that category. There are also other circumstances for which a special enrollment period may apply when it comes to Medicare Advantage and prescription drug plans.

What you should know

  • 1 Original Medicare offers a special enrollment period for those who have employer health coverage past age 65.
  • 2 The special enrollment period lasts for 60 days.
  • 3 There is also a special enrollment period for Medicare Advantage Plans and Medicare prescription drug plans.
  • 4 Depending on the type of Medicare coverage you’re interested in, the special enrollment period process may vary.

Not everyone automatically needs to enroll in Medicare when they turn 65. If you or your spouse is still working and has employer health coverage, you may want to wait until that employment ends to enroll. At that point, you can enroll during what is known as the special enrollment period (SEP), without penalty.

This means you don’t have to wait until the next general enrollment period (which is every January 1 to March 31 for those who miss their initial enrollment), for which you’d have to pay a higher premium.

There are also special enrollment plans that can be used for Medicare Advantage and Medicare prescription drug coverage if life circumstances change. These SEPs allow you to opt in or out without having to wait for the open enrollment period (which is October 15 to December 7 each year).

What qualifies as a special enrollment period for Original Medicare?

Original Medicare refers to Medicare Part A (hospital insurance) and Part B (medical insurance). Most people enroll in Original Medicare during initial enrollment around the time they turn 65. If you do not enroll during initial enrollment, you can enroll later on either through general enrollment (which incurs a penalty), or you may qualify for a special enrollment period.

“You can qualify for an SEP for original Medicare when you would be leaving creditable coverage (employer coverage) and coming into Medicare after age 65,” says Keith Armbrecht, founder of MedicareOnVideo.com. 

In fact, if you’re over 65 and you or your spouse is still working and covered by a group health plan, you can get Original Medicare through a special enrollment period anytime you want. However, once that coverage ends, you have an eight-month window to sign up for Part A and/or Part B through special enrollment.

Note: If you’re paying for COBRA, you will not qualify for a special enrollment period since that’s not considered employer coverage.

What is the special enrollment period for Medicare Advantage Plans?

When it comes to Medicare Advantage Plans (Part C), there are a number of reasons that you can qualify for a special enrollment period, says Armbrecht. These may include:

  • If you move and your plan is not available in the new location.
  • If you move to a location with other plan options.
  • If you return to the United States after living abroad.
  • If you are released from prison.
  • If you leave an employer that had coverage.
  • If you get the chance to enroll in other coverage though employment or a spouse.
  • If you enter or leave a nursing home or other care facility.
  • If you had Medicaid, but are no longer eligible.

“Another big one is if you develop a chronic condition,” says Armbrecht. “There are Medicare Advantage plans that specialize in certain chronic conditions like diabetes. So there is a special enrollment period to find the right plan for your needs,” he says.

What is the special enrollment period for Medicare prescription drug plans?

Medicare Part D (prescription drug plans) also offer special enrollment periods. They basically mirror the same qualifications as the Medicare Advantage plans.

How do I apply for Medicare special enrollment?

For Original Medicare

To enroll in Original Medicare during a special enrollment period, you must submit the application to Social Security. “You will need an employer coverage form that shows you had creditable coverage while you were working,” says Armbrecht.

For Medicare Advantage and Prescription Drug Plans

For Medicare Part C and D, you have to enroll directly through Medicare. You should first contact them to confirm your eligibility, advises Armbrecht. He also points out that Medicare’s phone number (1-800-MEDICARE) is available 24/7, and that representatives are generally very knowledgeable and helpful.

This expert was consulted for insight into the medicare special enrollment period:

Keith Armbrecht, founder of MedicareOnVideo.com

Leron headshot
Contributing Expert:

Leron Moore, Medicare consultant

Leron Moore has guided Medicare beneficiaries and their families as a Medicare professional for nearly 15 years. First as a Medicare provider enrollment specialist, and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.