Medicare Special Enrollment Period (SEP) for Part A and/or Part B
This article was updated on: 12/21/2017
A Medicare Special Enrollment Period (SEP) can let you sign up for Original Medicare Part A and/or Part B outside of regular enrollment periods. If you’re not eligible for an SEP, you’ll have usually to wait until the next General Enrollment Period to sign up for Part A and/or Part B. You might also have to pay a late enrollment penalty for not signing up when you were first eligible.
Why would I need a Medicare Special Enrollment Period?
Medicare has limited enrollment periods for Part A and Part B. Many people are automatically enrolled when they turn 65 or qualify through disability. Read about automatic enrollment and Medicare’s usual enrollment periods.
Some people delay enrollment in Original Medicare, Part A and Part B, for a variety of reasons. For example, if you have group health coverage when you’re first eligible for Medicare, you may wait to sign up for Medicare Part B to avoid paying another premium. In this case, Medicare Part B Special Enrollment Period may be available.
When might I qualify for a Medicare Special Enrollment Period?
Certain situations may qualify you to enroll in Part A and/or Part B using a Medicare Special Enrollment Period. Some qualifying situations may include:
- If you had other health coverage based on current employment, such as through your employer or your spouse’s
- If you were volunteering in a foreign country
- If you have TRICARE (health insurance for military members and their families) and qualify for Medicare because of disability, end-stage renal disease (ESRD), or Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS)
- If you were living overseas when you turned 65
Medicare Special Enrollment Period for the working aged
If you (or your spouse) are still working when you turn 65 and have group coverage through an employer or union, you can generally delay Part A and/or Part B. When that employment – or your health coverage – ends, you can typically enroll in Part A and Part B with a Medicare Special Enrollment Period. You have eight months to enroll, beginning the month that employment or employment-based coverage ends – whichever happens first. You may not have to pay a late enrollment penalty for not enrolling when you were first eligible.
The health coverage must be based on current employment (either through your own or your spouse’s employer). You can either enroll in Part A and/or Part B while you’re still covered through the group plan, or during the eight-month Medicare Special Enrollment Period (SEP). This SEP starts the month that your insurance (or the employment that it’s based on) ends, whichever happens first. This Special Enrollment Period occurs regardless of whether you decide to get COBRA coverage.
Keep in mind that COBRA and retiree health insurance don’t count as coverage based on current employment and won’t qualify you for a Medicare Special Enrollment Period when it ends. You also won’t get a Medicare Special Enrollment Period if your group coverage or employment ends during your Medicare Initial Enrollment Period. In that case, you’d join Part A and/or Part B during your Initial Enrollment Period.
Medicare Special Enrollment Period for international volunteers
Individuals volunteering in a foreign country may be able to enroll in Part A and/or Part B with a Medicare Special Enrollment Period when they return to the United States. To qualify for a Medicare Special Enrollment Period, you must:
- Have volunteered for at least 12 months outside of the United States
- Have volunteered for a tax-exempt program
- Have had other health coverage for the duration that you served overseas
Medicare Special Enrollment Period for disabled TRICARE beneficiaries
TRICARE is health insurance for retired and active-duty service members and their families. If you’re a retired service member, you must enroll in Part B to stay eligible for TRICARE benefits. However, TRICARE beneficiaries who qualify for Medicare based on disability, Lou Gehrig’s disease (ALS) or end stage renal disease (ESRD) may qualify for a Medicare Special Enrollment Period if they didn’t sign up for Part B during their Initial Enrollment Period. This 12-month SEP starts on:
- The last day of the person’s Initial Enrollment Period, or
- The month that the person is notified of Part A enrollment
This Medicare Special Enrollment Period can only be used one time during the TRICARE beneficiary’s lifetime.
Medicare Special Enrollment Period if you were living overseas
There are other situations where you may be able to enroll in Medicare outside of normal enrollment periods without a Special Enrollment Period. This includes if you were living in a foreign country when you turned 65 and were first eligible for Medicare. Since you need to be living in the United States to have Part B, you can sign up in the first month after you return to the country. This only applies if you were overseas and not receiving Social Security benefits when you turned 65. Otherwise, you may have to pay a Part B penalty when you move back to the United States. For more information on Part B enrollment for U.S. citizens living abroad, contact Medicare at 1-800-MEDICARE (1-800-633-4227). If you’re a TTY user, call 1-877-486-2048. Customer service representatives can be reached 24 hours a day, seven days a week.
Do you have questions about Medicare Special Enrollment Periods? If you’re already enrolled in Original Medicare, Part A and Part B, you may wish to look at adding a Medicare Part D Prescription Drug Plan or a Medicare Supplement policy. Whatever Medicare plan option you’re looking for, I can help. Additionally, you can schedule a phone call with me, or request an email from me with personalized plan information. If you’d like to compare plans now, use the Compare Plans or Find Plans buttons on this page.
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