I know there are different types of Special Enrollment Periods for Medicare. Can you review these for me? And what is a Special Enrollment Period, anyway?
Simply put, a Special Enrollment Period (SEP) lets you make changes to your Medicare Advantage plan or Medicare prescription drug plan coverage outside the previous “regular” enrollment periods.
At last count, there are more than twenty-five types of SEPs. I’m not going to list all of them for the sake of sanity and brevity. However, if you have one or think you might have one that applies to your situation, here’s where an excellent independent Medicare insurance agent comes in handy. You can also call a Medicare insurance company and ask. The telephone reps should know, but they might have to dig into their notes for a bit to find the answers. Again, even good Medicare insurance agents can’t remember all of these off the top of their heads, but they know where to find them and how to use them when they come up. I’d use an agent if you think you have some sort of event or extenuating circumstance outside of the IEP, AEP, and OEP that you need help with.
Commonly Used Special Enrollment Periods
Here are a few of the more commonly used SEPs:
MEDICARE ADVANTAGE “TRIAL PERIOD” SPECIAL ENROLLMENT PERIOD
People who enroll in a Medicare Advantage plan for the first time get a “trial period” (up to twelve months) to try out Medicare Advantage. If you do this and end up not liking the Medicare Advantage concept or plan, this SEP allows you to disenroll from your first Medicare Advantage plan and return to Original Medicare. You’d get a “guaranteed issue right” to purchase a Medicare supplement plan without any type of underwriting. The Medicare Supplement companies have to accept you.
This right lasts for sixty-three days after disenrollment from the MA plan, so, again, timing and planning are critical here. If you dropped a Medicare Supplement policy to join a Medicare Advantage plan for the first time, regardless of age, you also get a “trial period” (up to twelve months) to try it out. If you don’t like it, you can go back to your Medicare supplement (up to 12 months) as well.
This one is easy. It’s a SEP you can use when you’re on Medicare to change your Medicare Advantage or Medicare Part D Prescription Drug Plan if you permanently move. If you move across the street or usually within the same county, you probably won’t qualify for this. But if you move out of your current county or state, you’ll probably move out of the service area in which the insurance company operates. If you do this, you can sign up for either a new Medicare Advantage plan or Medicare Part D Prescription Drug Plan, depending on your situation.
SEP FOR INSTITUTIONALIZED INDIVIDUALS
This one is for folks in nursing homes or residential long-term care facilities, some skilled nursing facilities, psychiatric hospitals, rehabilitation hospitals, long-term care hospitals, and swing beds. It allows you to enroll in or switch Medicare Advantage plans or Medicare Part D Prescription Drug Plan when you move into, reside in, or are discharged from certain long-term care facilities to join or disenroll from a Medicare Advantage plan. If you (or your loved one) qualify for this, you may join a Medicare Advantage plan or Medicare Part D Prescription Drug Plan, switch to a different Medicare Advantage plan, or disenroll from Medicare Advantage and go to Original Medicare.
SEP FOR PEOPLE WITH LIMITED INCOME
There are a couple of these, and all of them revolve around whether or not you’re eligible for one of the many special “financial help” programs offered by states and the federal government. Generally, if you make more than around $18,000 as an individual or under $30,000 as a couple per year, don’t bother; you won’t qualify.
I would not try to tackle anything DIY outside of the IEP, AEP, and OEP. There’s a lot you could potentially mess up or miss out on, and you definitely don’t want to be in a position where you’ve missed essential deadlines because you didn’t understand the various election periods.You’ll want to get the guidance and assistance of a good independent Medicare insurance agent or experienced Medicare insurance company phone representative to walk you through.
I hope this helps!
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Author Bio Matt Feret is the author of the Prepare for Social Security -The Insider’s Guide and the Prepare for Medicare – The Insider’s Guide book series and launched PrepareforSocialSecurity.com to help people get objective answers to questions about Social Security and Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.