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Medicare Special Enrollment Period (SEP)

There are certain regular enrollment deadlines in which you can register yourself for the insurance program. However, there are certain circumstances in which you can enroll yourself outside of the regular times. This duration is known as the Medicare Special enrollment period. If you qualify for this specific subscription duration, you can subscribe to Medicare outside of your Medicare initial and general enrollment time. Medicare Special enrollment periods are specifically for Original Medicare i.e. part A and part B whereas there is a special election period for Medicare Advantage and Medicare Prescription drug plan.

Special Enrollment Period for Original Medicare

You will be choosing this duration for a subscription when you have delayed the subscription for original Medicare. There are certain conditions in which you can delay and subscribe in a specific subscription period.

Delaying Part A Subscription

Medicare part A is premium-free and people get an automatic subscription if they have paid taxes and have worked for 10 years (40 quarters). If you have no work history to register for a premium-free part A insurance program and you have to delay the subscription because of your medical cover from your employer, you can delay the subscription for part A and can enroll in a specific subscription time. If you have not used this duration for registering to ‘part A’ you will have to pay a penalty for late enrollment. If you have these circumstances:

  • If you have health cover-up from your or your spouse’s employer you can enroll yourself anytime during this health cover-up for part A and part B.
  • You can enroll yourself for Medicare part A and part B during the eight-month duration that starts when your employment or employer-based fitness insurance ends. If your fitness insurance ends during the Medicare initial enrollment duration then rules of a specific subscription time do not apply to the subscription.

If you have not registered yourself in these eight months you will have to wait for the Medicare general enrollment duration. The Medicare general enrollment duration starts on the 1st of January. If you do not enroll on time you will have to pay a penalty as well as a higher premium for Medicare part B subscription. If you are taking social security benefits or disability benefits, you can still use a special enrollment period.

Delaying Part B enrollment

Medicare part B usually has similar insurance as your health scheme possesses. Most people prefer to take their employer-based medical cover. If you are still working at the age of 65 and are taking fitness medical covers from your employer you can delay your Medicare part B subscription until the cover-up ends. In this case, you will have a special enrollment period for a subscription in which you can subscribe anytime whenever your well-being medical cover ends. You can delay your registration for medical insurance without paying a 10% monthly premium penalty.

Special Election (Enrollment) Period for Medicare Advantage and Medicare Prescription Drug plan  

This special election period is somehow different from the specific subscription duration for original Medicare. This special election period for Advantage/ prescription drug plans is specifically for people who lost their cover-up because of any reason. Like if you have moved away from the program’s cover-up area or your program has stopped accepting Medicare. Other than this people can qualify for a Special registration time span if their area has been hit with a natural disaster. There are certain limitations for this specific subscription duration in case of a disaster that you need to follow:

  • The emergency is declared in your area by the Federal Emergency Management Agency (FEMA).
  • You were living in the country when FEMA declared an emergency or disaster in the area.
  • When FEMA declares an emergency or disaster in your country you have a valid election duration going on.
  • You have not changed your medical cover after the emergency or disaster was declared.
  • The special sign-up time has not expired.

There are certain conditions in which you can take advantage of the Special enrollment period. These are as follows:

Unable to Qualify Health Coverage

 There are different situations in which you qualify for health cover-up and in case of failure to qualify for fitness insurance, you can use a specific subscription duration.

  • You were taking well-being benefits from your employer and your employer-based medical cover ends or the employer does not consider the insurance as qualified or has stopped offering medical covers.
  • Medically needy insurance such as Medicaid or Children’s Health Insurance Program (CHIP).
  • Medicare
  • If your medical cover ended because of the decrease in your income you get eligible for a medical cover and can take benefits from SEP.
  • You are taking fitness insurance via your parents and it ends up. You can enroll yourself during this time span if you are at the age of 26.

For the first entitlement in marketplace insurance, you need to provide documents that prove your eligibility for the subscription at this specific time.

Change in Household size

The household size changes if you get married, have a baby, or adopt a child. Moreover, if you become dependent because of any reason you can take a subscription for this duration. In the case of marriage, your spouse must have been taking some medical cover before marriage. If your spouse was not living in the service’s area or was not a resident of the U.S then the rules for SEP will not apply to that.

Change in your Living Area

To qualify for a fitness insurance scheme it is necessary to live in the area that is covered by that specific service plan. If you move from your primary living place then you qualify for SEP in certain conditions:

  • Moving to a new country.
  • Moving to the US from another country.
  • Moving to or from the area of your school.
  • Moving to or from your employment or shelter.

This only applies if you are moving permanently as moving temporarily for the sake of worker treatment does not qualify you for SEP.

Change in eligibility or Help to pay for coverage

  • If you were to register in coverage and report a change that makes you recently eligible or ineligible for help paying for coverage or changes could also make you help to pay out the cost.
  • You become newly eligible by moving to the U.S or becoming a member of a federally recognized tribe or having gone through income change (increase or decrease).
  • You become newly eligible as you have recently completed your imprisonment.

Enrollment Error

Having detailed information about the specific program is necessary before subscribing. You qualify for SEP if you were not registered in your desired program because of some misunderstanding or misinformation. Any technical error could also occur like wrong data uploaded on the website at the time of subscription that leads to subscription error.


What is a Special Enrollment Period?

The time outside the Medicare open subscription duration or Medicare initial entitlement period is known as SEP. A person qualifies for this time scale if he/she has certain life events including loss of insurance scheme, moving from a primary living place, or increased household size. This is the eight months duration that starts on the day when your health plan ends or the employment ends. You can enroll yourself during this duration without paying any penalty along with the premium. You can subscribe anytime during the time span you are covered by your employer-based insurance.

What is the Usage of Special Enrollment Period for Original Medicare?

If you are not automatically registered for original Medicare you need to sign up for that. In case you have any prior health insurance from your or your spouse’s employer, you can delay your subscription for Medicare part A and Medicare part B. You can subscribe anytime within this time scale during your employer-based fitness coverage. This duration is available for Original Medicare that you can utilize to register whenever your well-being insurance or employment ends.

What is the Special Election (Enrollment) Period for Medicare Advantage?

If any person has lost their insurance or moved from the coverage area they can subscribe during this Special signup duration. This time span starts on the 1st of January and ends on the 31st of March. You can easily change your program or insurance during this duration without any penalty. If you were taking a long-term facility like hospital care or nursing and have recently moved from this service. However, if Medicare has canceled your program’s contract and you have lost your insurance.

What is the Use of Special Election (Enrollment) Period for Prescription Drug Plans?

You can add, change or renew your Medicare prescription drug plan coverage in this duration outside the open enrollment period or annual election period. This special registration time scale provides subscription opportunities without paying any penalty.