Medicare Special Enrollment Period (SEP) for Part A and/or Part B
This article was updated on: 08/03/2015
A Special Enrollment Period (SEP) allows you to 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 to wait until the next General Enrollment Period to sign up for Part A and/or Part B, and you may have to pay a late enrollment penalty for not signing up when you were first eligible.
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. Similarly, you may also decide to delay Medicare Part A enrollment if you don’t qualify for premium-free Part A. In these cases, an SEP for Part A and Part B may be available.
Normally, you’d enroll in Medicare Part A and/or Part B during your Initial Enrollment Period. This is the seven-month period that starts three months before your 65th birthday, includes the month you turn 65, and ends three months later. Other people may enroll in Medicare Part A and/or Part B before 65 if they have certain disabilities and receive disability benefits for 24 consecutive months. If you qualify for Medicare based on disability, including end-stage renal disease (ESRD) or Lou Gehrig’s disease, you don’t need a Special Enrollment Period to sign up for Medicare.
If you missed your Initial Enrollment Period, you can also enroll in Part A and/or Part B during the General Enrollment Period, the open enrollment for Original Medicare that occurs from January 1 to March 31 every year. If you enroll in Medicare Part A and/or B during the General Enrollment Period, it will become effective July 1 of that year. However, keep in mind that you may have to pay a late enrollment penalty for not signing up when you were first eligible. If you pay a premium for Medicare Part A, this penalty is a 10% higher premium for twice the number of years you were eligible for Part A, but didn’t enroll. For example, if you were eligible for Medicare Part A for 4 years, but didn’t enroll, then you’ll have to pay a 10% higher premium for 8 years. If you don’t sign up for Part B when you’re first eligible or if you drop it without having other health coverage, you may have to pay a 10% higher premium for every 12 month period that you were eligible for Part B, but didn’t join.
Certain situations may qualify you to enroll in Part A and/or Part B using a Special Enrollment Period. Some qualifying situations may include:
- If you had other health coverage, such as through an employer.
- If you were volunteering in a foreign country.
- If you have TRICARE and qualify for Medicare because of disability, end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS).
- If you were living overseas when you turned 65.
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 delay Part A and/or Part B and enroll with a Special Enrollment Period when your health coverage or that employment ends. 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 work 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 with the eight-month Special Enrollment Period that 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 an SEP when it ends. You also won’t get a Special Enrollment Period if your group coverage or employment ends during your Initial Enrollment Period. In that case, you’d join Part A and/or Part B during your Initial Enrollment Period.
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 Special Enrollment Period when they return to the United States. To qualify for a 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.
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 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 Special Enrollment Period can only be used one time during the TRICARE beneficiary’s lifetime.
Special Enrollment Period if you were living overseas
There are other situations where you can 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 back 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 your potential Special Enrollment Period? 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 you’re looking for, I can help. To see more about me, use the “View profile” link below. 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 buttons on this page.
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