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Medicare Special Election Period (SEP)

Medicare Special Election Period refers to a special enrollment time when Medicare beneficiaries can opt for additional advantages. One can also consider this period as Part D coverage where they can extend the annual medical schemes.

This open enrolment term sustains for a limited time every year. Therefore, before the term ends, you need to sign up and register for surplus benefits. Read below for more details regarding the Medical special Election policy.

Special Election Period (SEP)

Life is uncertain, and aging life poses many challenges. Especially when you have to live up your life depending on stipulated money, you got to be very careful. Furthermore, with aging medical expenses become an indispensable part of life. A Medicare program always supports you throughout your medical emergency. But what if the benefits are not adequate to meet the requirement? In that case, SEP appears to be a true blessing.  Even your voluntary step to avail better medical facilities is also encouraged in the time.

Special Election term offers you limited scope to adopt a better Medicare Advantage program. It also lets you change the Medicare prescription drug plan policy apart from your regular enrolment terms. In fact, you have two options to avail of the programs.

  • Special enrolment term for qualifying life events for two months
  • The special enrollment period for those who are working past 65 for eight months

These user-friendly and flexible let you keep you in shape, under two conditions. It is equally beneficial for users who don’t even have an existing Medicare plan. You will get an eight-month time to opt for Parts A, B, C, and D. and if you have a Medicare plan you can additionally enroll for a Part D plan under two months of special enrollment term.

You still might have a skeptical idea about the Medicare policies. To clear all your doubts and find the ideal plan, keep reading the article till the end.

When can you enroll? 

The initial enrollment period (IEP) starts from 3 months before a person turns 65 and lasts for seven months. Apart from this general guideline, there are certain specifications and strict protocols to be eligible for the term. Without U.S citizenship or permanent resident proof for consistent five years, you won’t be able to enroll in the plan. Generally, if you already have Social Security and RRB (Railroad Retirement Board) benefits, it will automatically enroll your name when you turn 65. Apart from this, if you have ALS, you will qualify for the program automatically.  

 During this registration, a person can enroll in:

  •  Parts A and B
  •  Part C 
  •  Part D

In case of a few special circumstances, you can automatically be qualified for the terms during Special Election Period. For original Part A, Part B, you can avail the program if you have the given situation:

You or your spouse is disabled you are likely to get covered through an employer’s or union’s group health programs. Then, you can apply for Original Medicare to extend the term policy and take the additional benefits as long as you are working.

Suppose the policy of your union health scheme has recently ended and you want to switch for a better program. In that case, you will have eight months of time to sign up for Medicare. The term starts from the month after the employment ends. Apart from the general rule, in special circumstances, if the employee-based programs end, you can avail of Medicare Original (whichever happens first).

While the original Medicare plan follows the previous guideline, the medical advantage Plan and medical Prescription Drug programs are a bit different. As they cover additional benefits, they are provided in the following condition:

  • Moving to a new location that doesn’t cover the plan’s service area
  • Moving out of the facilities you have been provided from the healthcare unit
  • Losing the coverage term, like if Medicare cancel the plan’s contract
  • Want to have a special facility like a long-term care hospital or skilled nursing facility

Make sure you are qualified for the Special Enrollment Period

It’s a legit question to ask when you first come across the program. Moreover, if you are going through major changes in life, you might seek an extra hand to secure your future. The social Enrolment Period allows you to switch to a modified Medicare Advantage or prescription program.

To qualify for a two-month Medicare special enrolment period, you need to meet the following condition:

  • You move out of the service area of your program
  • Either your programs have stopped or have been closed for the area you live in. Significantly, it reduces the area covered under. Lastly, the program is receiving a low Medicare star rating.
  • You would like to switch for a five-star program at your preferred time or left your primary Medicare Advantage plan within 12 months of enrolling.
  • You move out of a certified institutional facility, for example, a nursing home.
  • Or you have enrolled in or are incapable of meeting the eligibility for a qualified state pharmaceutical program.
  • You already possess certified financial assistance; however, you lose eligibility for one of them.
  • You have enrolled in or leave the program of inclusive care for a senior citizen like PACE.
  • You gain or lose eligibility for Special Needs programs.

The citizen who works after 65 and qualifies to delay Medicare with creditable and reliable employee term can avail an eight-month Special registration period that allows one to register in Part A (for the first time), Part B, C, and D without any penalties.

However, this special registration term is considered to be a bit risky and complicated. As you have the entire eight months to get parts A and B, you get the primary two months to get the facilities of Part C or D without any additional charges. And, most importantly, if you register after the two-month mark, you have to compensate for enrolment penalties for the same. It does not matter if you end up with a stand-alone program, including Prescription Drug coverage.

In case you want to qualify for part B, you should possess a credible employer or union health coverage depending on your present employment. The special enrolment period starts after eight months of the ending date of the policy or when you leave your job.

What changes can I make during the Special Election Period?

It is certainly the most crucial point one should understand thoroughly before opting for a program. In fact, it is the driving factor that lets you trigger your enrolment decision. So, without further talk, let us get to the topic.

You can opt for potential changes during the SEP, based on the situation.

  • Shifting from Original to Advanced plan 
  • Shifting Medicare Advantage program
  • Changing prescription drug program
  • Discontinuing from an Advantage program and going back to the original Medicare.

However, switching programs come with a host of prerequisites. You can’t change your mind just like that. You should provide some logical reasoning and adequate paperwork to switch from one program to another. So, now take a glance at in which condition you are eligible to switch your existing plan?

Apart from the general eligibility criteria, here is a list of diplomatic situations that let you change the term programs:

Suppose you have moved to a new area and the plan doesn’t cover the medical advantages there.

  • You moved back to the United States after living abroad.
  • You were just got bail or released to the jail
  • You are no longer eligible for Medicaid programs
  • You are available for both Medicare and Medicaid
  • You are planning to have a long-term facility from a nursing home or preparing to move out from the policy.
  • You lost the Cost Plan that used to offer prescription drug benefits.
  • You are eligible for a low-income subsidy program.
  • You are suffering from a chronic disease and want to avail a beneficial program under the term.
  • You are planning to switch for a 5-star rating medical program
  • Medicare advantage representative misguided you to choose a wrong program
  • You have come across an administration delay. Instead of meeting all the criteria, you could not register for an advantage plan at the first phase.

Under this given situation, you can easily switch from one program to another. However, the date and time of the switching term entirely depends on the position you are in.

For those who are still unable to find their checklist to opt for a SEP, we have a good news for them. You can brace yourself for the next Annual Election Period. It is also known as the Open registration Period for Medicare Advantages and prescription drug policy. However, there is the general thumb of rule; you can also disenroll from the Medicare Advantage plan during the OEP or Open Enrollment Period, from January 1st to March 31st.

Your coverage starts at the point. 

  • You might choose to start policy any time between the first day of the month you moved (as you have already submitted the entire application) and up to three months after the Advantage Plan and Part D program receives the finished registration application.
  • You can choose to start policy any time between the first day of the month you shifted ( as you have submitted a completed application) and up to three months after your Advantage Plan or Part D program gets the entire registration application.

Below are the important issues for timing:

  •  If you tell the plan before you move, your chance to opt for a new program begins the month before you move and continues for two full months after you move.
  •  If you tell your program after your shift, your chance to change the program begins the month you tell your program, plus two more full months.

5-star special election term

When you enroll in a Medicare Advantage plan or any stand-alone Part D program, while your initial registration term, the beneficiary can take a special opportunity, they can switch to a 5-star rated program at their convenience. The term of switching is valid from December 8th to November 30th of the next year. Hence, the scheme term starts from the first day of the next month after we get the application. The entire process is named as the effective date.

However, Medicare changes the ratings every alternative year. Therefore it significantly impacts the plan you will be signing for.

Let us understand the intricate protocol in a simple way:

For example, if a particular Medicare Advantage plan possesses a 5-star rating in 2021 and loses one star in the next year, i.e., 2022. And you have already upgraded your version and are eligible for a 5-star program. In that case, you will be unable to choose the predetermined plan as it doesn’t have a 5-star rating anymore. And all these activities are applicable until November 30th of the same year.

Hence, during the 5-star SEP, you can only opt for a 5-star rated program from December 8th to November 30th. During the registration term you can practice the following benefits:

  • Disenrol from standard policy and register in 5-star rated advantage programs.
  • A shift from an Advantage plan to a 5-start rated advantage Medicare plan. 9in both cases with or without prescription  drug policy)
  • A shift from stand-alone prescription drug to 5-star rated stand-alone prescription drug programs.
  • A shift from one 5-star rated Medicare advantage Plan to another 5-tar program
  • Change or leave Medicare Advantage and Medicare Prescription  Drug program and register for a 5star rated program

Even though it is quite beneficial to switch from a standard or advanced program to a 5-star rated one. It is imperative to check all the details before you take the leap. Moreover, the switch should not be taken for the sake of 5-star. Rather, one should analyze the benefits and advantages they are likely to get from the program. In most cases, the Medicare consultants literally manipulate the users to come to terms with the switching. Hence, as a responsible citizen, you should read the terms and conditions thoroughly and land up for the final leap. Here, we have listed a few considerations that might help the users to understand whether they need the switching at all!

Remember, with a new one has to face new rules and consequences. Take a look at the protocols that are going to be applied to this election term:

First of all, when you switch from a Medicare Advantage plan including prescription drug coverage to a 5-star program without prescription drug coverage, you have to wait for the Annual Election Period. Then, you can apply for Medical Part D. On top of that; you can pay a Medicare late allotment fee if you do not have other creditable prescription drug coverage.

The following consequence can be heartbreaking if you don’t have a medical savings account plan or a Private Fee service program. Furthermore, if you have an Advantage plan with prescription drug coverage and register in a stand-alone Medicare Prescription  Drug Program, the policy’s terms automatically eliminate your access to Medicare Advantage. Then it will send you back to Original Medicare.

Now, the discussion doesn’t make any sense if you don’t qualify for a 5-star program, right?   Hence, the most important thing that matters here is whether you are at all eligible for a 5-star plan or not! So, let’s dig deep into the topic and find out the eligibility criteria:

You should have Part A and B if you seek to shift to the Advantage plan. In case you want to continue with the Original Medicare plan, registration in a stand-alone Medicare Prescription Drug program is necessary.

If you want to switch to Medicare Cost Plan, you must have access to at least Part B

You are a resident of the service area of the plan; you will apply for the process

You can have a SEP if you The SEP works till The term starts
Want to register in a Medicare Advantage or Part D plan that has an overall Plan Performance Rating of 5-star, and you are otherwise eligible to register in the plan. (For example, you live in the plan’s service area.) Plan Performance Ratings are released every alternative year and apply to the following calendar year. Your SEP to join a 5-star Advantage or other plan begins December 8th of the year before the plan is considered a 5-star plan. It continues through November 30th of the year; the plan is considered a 5-star plan. You can utilize this SEP to change the plan one time per year. Enrolling from December 8th through December 31st is applicable on January Enrolling from January 1st through November 30th is effective the month following the month you submit an registration form.

Medical Part A and B term

If you miss the initial registration term, you will have the chance to register for the process during the Special Enrollment Period. If you were unable to sign up for Part B during considering the eligibility as you are covered under a privileged group, you could sign up for Part A and B in the giving situation:

  • Anytime you are covered by the group of health programs
  • The 8 month duration starts the month after the employment/coverage ends  

To be eligible for Part A and B, you should have a permanent residentship of 5 straight years. If you are not getting retirement benefits from the social security institutions, you will be availing of the plan. And most importantly, one must sign up for Part A when you meet the age requirement. If you have been receiving permanent disability benefits, the road map would be smoother for you.

Part C and D coverage

The Advantage plan C coverages is almost the same as the initial coverage election term. To enroll for Part C, you can sign up during AEP between October 15th to December 7th. For the efficiency of the coverages, you have to wait until January 1st of the following year. Apart from this, you can always enroll for SEP if you meet the eligibility criteria. The rewarding thing about Part C is you don’t have to pay any penalty for not signing up.

Medicare Part D offers some advantageous benefits. Its coverage includes prescription drug, and just like Medicare C, it can be availed through a private insurer. And top of that, Medicare-approved the entire plan. However, it is fundamental to have Medicare Part A and/or B register for the benefits. Needless to say, you should live in the service area for the dun plan you want to enroll.

Special Enrolment Period

You can have an SEP if Your SEP can be availed The Coverages start
You, without any fault of your own, lose prescription drug coverages that is at least as good as or even better than Medicare’s (creditable) or your drug policy plan and it is reduced so that it is no longer creditable. (This does not include losing the prescription drug coverage because you do not pay, or are unable to afford, the premium.) Your SEP to join the Medicare Advantage programs with prescription drug coverage or a stand-alone prescription drug plan starts the month you are told your policy will end and lasts for  2 months after you lose your coverage term or  2 months after you receive a notification whichever is later. The first day of the month after you submit an entire application, or Up to two months after your SEP ends, if you request for it.
You want to disenroll from Medicare prescription drug policy to maintain or enroll in another type of creditable prescription drug coverage like VA, TRICARE, or a state pharmaceutical assistance program (SPAP) that provides creditable policy. You can use this SEP to disenroll from a Medicare Advantage Plan with prescription drug coverage or a stand-alone Medicare prescription drug program whenever you are able to register in another type of creditable policy. The first day of the month after your plan receives your disenrollment request.

To Wrap Up

Well, for many reasons, it is also important to consider the compensation you have to pay if you want to postpone the term. If you want to stick to the same program and the covered term under a union health insurance program, once your turn 65, you are permitted to delay the Medicare enrollment. However, the process is allowed in a specific condition and for a stipulated time when it is needed without providing any penalty.

Frequently asked question

What is the Medicare Special Election Period?

The special election period suggests a special registration time when the Medicare beneficiaries change their Medicare Advantages and policy outside of the standard annual open registration term.

If I have Medicare; do I need other insurance too?

Look, Medicare care doesn’t cover all the medical needs. However, there are specific ways where you can avail of a comprehensive policy for some medical situations, like routine vision, dental, and hearing care, etc. Hence, ideally, you don’t need to have other insurance.

How to get Dental and Vision coverage with Medicare?

 Original Medicare does not cover all medical needs. Especially when it comes to routine care programs, you will not have any added advantages. In that case, you have to shift to the Advantage plan, where extra care facilities are included.

What is the special enrollment term in Medicare?

SEP or Special Enrolment Period refers to the time when you can register for Part B, D, or any private health program.

What is the special election term related to Medicare Part D policies?

With the Special Enrolment Period, Medicare beneficiaries can join, change or drop the prescription drug program. Or can opt for MA (Medicare Advantage plan), AEP (Annual Open Enrollment Period). It runs from October 15th to December 7th.

At what age should one apply for Medicare?

If you do not qualify for the automatic registration process, you can sign up during the IEP or Initial Enrollment term. In a typical situation, when you are three months before 65, you can enroll for Medicare. And you have any disability, you are likely to get registered before age 65.

How long does Medicare Special Election Period Last?

A SEP is an eight-month duration that starts from the month you quit the job or unit policy ends. Once you come across one of the mentioned situations, you are likely to start the program immediately.