Medicare Special Enrollment (Election) Period

By: Meredith Miller
Published: Wednesday, November 28 2018
Last Updated: 3 years ago

So the time has come. You've turned 65! Yay for retirement, right? Well, for some this is not the case. With full age retirement increasing and a growing population of people who have not saved a dime for retirement, we face an aging workforce. Now a perk of not hanging up the apron is the fact that you are still entitled to employer-based coverage, even though you are 65 years or older.

If you choose to keep employer-based coverage, you will be eligible for a Medicare Special Enrollment period also known as a Medicare special election period when you finally throw in the towel.

What Is The Medicare Special Enrollment Period (SEP)?

The Medicare Special Election Period is a time when you can enroll outside of another type of enrollment period. The SEP is a stopgap for those who could not or did not enroll when they first were eligible to start the Medicare program.

Requirements To Qualify For A Special Enrollment Period

The requirements to qualify for a Medicare Special Enrollment Period are the following. You must have experienced one of the following situations. Keep in mind that this is not an extensive list:

  • Loss of Employer-based coverage (through you or your spouse's job)
  • Retirement
  • Cobra offers
  • Change of Address
  • Release from Jail
  • Loss of Medicaid (yes you can get Medicaid when you are over 65!)
  • Plan changes or Medicare contract rescindments
  • Dual Medicare/Medicaid eligibility
  • Extra help for PDP (prescription drug plans)
  • Misrepresentation/fraud

Why There Is A Medicare Special Election Period?

The reason for the Medicare Special Election Period is to allow those beneficiaries who have circumstances outside the norm, the option to allow them a change to the health coverage they receive. Some people are in positions where it is to their benefit to delay Medicare, and they may not finish up the old health insurance during a convenient time of the year. That is when an enrollment period is open. To allow them the freedom from worry, Medicare enacted the Special Election Period.

Change Of Residence

Changing where you live can give you a SEP if you are in a Medicare Advantage plan. With Original Medicare, it doesn't matter where you live, so long as the doctor you see accepts Medicare. Whereas with Medicare Advantage, the plan you have may only serve a certain area, and it restricts you as to whom you may get Medical treatment from.

Loss Of Current Coverage Meets

When you finally decide to retire, or your boss decides to no longer offer you coverage, this opens you up to a Special Election Period, where you can sign on to Original Medicare or a Medicare Advantage plan.

New Coverage Opportunity

A new coverage opportunity would be when your boss may offer you COBRA or a Medicare Advantage plan is no longer being offered and have been pre-signed up in a similar plan. With Medicare Advantage plans, most beneficiaries would wait until the open enrollment period to sign up in such a plan.

Your Current Plan Changes Medicare Contract

Medicare can at points of a contract, revoke the contract with a particular plan if they are underperforming or not giving the best service possible to the beneficiaries. In that case, you would receive a letter from Medicare inviting you to change plans due to this or other issues with the current insurer. This letter would trigger Special Enrollment requirements and allow a change.

Other Circumstances That Meet Special Enrollment Requirements

Other circumstances that would warrant SEP requirements would be the release from jail, having a disability for 24 months, ESRD (end-stage renal disease) or loss of Medicaid. It is important to note that if you are receiving extra help to pay for Medicare, you may switch your plan at certain times of the year.