Do You Qualify For The Medicare Special Enrollment Period?
You may be able to enroll in Medicare outside of normal enrollment periods. These cases are uncommon but if you match specific conditions, you may qualify for the Medicare Special Enrollment Period (SEP). If you qualify for the Special Enrollment Period, then you will be able to bypass normal enrollment periods. So you may be able to sign up when you’d like under certain rules described below. The normal periods you will be able to bypass are the General Enrollment Period (GEP) and your Initial Enrollment Period (IEP).
What are the conditions for a Special Enrollment Period? If a group health plan covers you, either from your employment or your spouse’s, and you are 65 or older. Then you can sign up for Medicare Part B during a Special Enrollment Period. This means that you can postpone your enrollment in Medicare Part B. You will not have to pay a 10% premium penalty for late enrollment and you will not have to wait for the General Enrollment Period.
If you do not enroll in Medicare Part A when you’re first eligible, a late-enrollment penalty may apply. If a penalty does apply then you need to pay a Part A premium. Most people bypass paying a Medicare Part A premium because they have paid Medicare taxes and worked at least 10 years (40 quarters). However, what happens if you don’t have enough work history and you want to get premium-free Part A and postpone Medicare enrollment? Then you can avoid paying a premium if you qualify for a Special Enrollment Period to sign up for Part A. To qualify, you must be 65 or older and have employer-sponsored coverage.
Below are the conditions of when you can enroll during the Special Enrollment Period:
- If you’re covered by way of a union’s group or employer’s health plan (if you are disabled then a family member’s or your spouse’s). Then, as long as you (or family member / spouse if disabled) is working, then you can enroll for Original Medicare (Part A and Part B) at any time.
- If your coverage by way of a union’s group or employer’s health plan ends. Then you have an eight-month period to sign up for Medicare. This will start the month after your employment-based health plan insurance ends, or the employment ends. If your employment or employment-based health plan coverage ends during your IEP, then Medicare Special Enrollment Period rules do not apply.
What happens if you do not enroll in Medicare by the end of the eight month period?
Then you must wait until January 1 of the next year which is the next General Enrollment Period. You may also have to pay a late enrollment penalty for Part A if you do not qualify for premium-free Medicare Part A. You also may have to pay a higher premium for Medicare Part B as well.
If a group health plan covers you (either you or a family member’s current employment) and you also receive Social Security benefits. Then you also have a Medicare Special Enrollment Period. If you want to know more on conditions that qualify you for a special enrollment period, then contact Medicare at 1–800-MEDICARE (1–800–663–4227), open 24/7. TTY users can call 1–877–486–2048.