There are some cases where you may enroll in Medicare or switch plans outside the regular enrollment period. This is known as the Medicare Special Enrollment Period. Let’s go over how you may qualify and what you need to know about this Special Enrollment Period.
Qualifying for Medicare Special Enrollment Period
With Medicare, you may qualify for a 2-month Special Enrollment Period with certain qualifying life events.
If you already have Medicare, you may qualify for a 2-month Special Enrollment Period with certain qualifying life events. This 2-month period allows you to switch to a different Medicare Advantage or Part D prescription drug plan. Here are a few ways you can qualify for the Medicare Special Enrollment Period:
- You change where you live. Whether you move to an area that isn’t in your plan’s service area, move to a new area still within your plan’s service area but now have new options, you moved back to the U.S. after living outside the country, or you move into or out of a qualified institutional facility (like a nursing home), these are a few ways you can qualify for the Special Enrollment Period.
- You lose your current coverage. You also can qualify if you gain or lose eligibility for Medicaid, left coverage from your employer or union, your plan stops serving the area where you live, or your plan significantly reduces its provider network.
- There’s a chance for you to get other coverage. Other ways to qualify is if you have a chance to enroll in other coverage offered by your employer or union, you have or are enrolling in other drug coverage as good as Medicare prescription drug coverage, or you enroll in the Program of All-Inclusive Care for the Elderly (PACE) plan.
- There are other special situations. There are other situations you may also qualify like if you enroll in a State Pharmaceutical Assistance Program (SPAP) or lose SPAP eligibility, you gain or lose eligibility for a Special Needs Plan, you joined (or not joined) a plan due to an error by a federal employee, or you weren’t properly told that your private drug coverage was (or wasn’t) as good as Medicare drug coverage.
Keep in mind, some situations not listed here may also qualify for Medicare Special Enrollment Period. If you have any questions about your situation, contact us and we would be happy to help you.
Working Past 65 Special Enrollment Period
We have covered this topic in its own post on our blog, but we’ll go over it again here quickly as a reminder! For those who work past 65 and qualify to delay Medicare coverage with a credible employer, you can do so without penalty. When you decide to retire, or your employer coverage expires, you’ll enroll during an 8-month Special Enrollment Period (with some caveats). This allows you to enroll in Part A (if you haven’t already), Part B, and Part D.
This Special Enrollment Period can be a little tricky though. We mentioned there are some caveats to the 8-month period above, so here is what you need to know. You have the whole 8 months to enroll in Part A & B, but you only get the first 2 months to enroll in Part D without penalty. Enrolling after the 2-month mark will mean dealing with late enrollment penalties.
We’re Here to Help
Knowing when and if you qualify for the Medicare Special Enrollment Period can be confusing. We want to make this process as easy and uncomplicated for you as possible. Jeffery Insurance is here to help you understand if you qualify and will help answer any questions about Medicare. We are based in Scottsdale but are happy to assist you no matter where you are in Arizona. We are Arizona’s health care resource!
