Last month we reviewed what OEP means (Open Enrollment Period), or commonly called the “disenrollment period.” We mentioned special circumstances that would create or trigger a Special Enrollment Period (SEP), and as promised, that’s our topic for this month.

To help you distinguish between the two, remember the open enrollment period time frame is from January 1 to March 31 of each year. The rules give you a ONETIME opportunity to:

  • Switch to a different Medicare Advantage plan
  • Drop your Medicare advantage plan and return to original Medicare. (Part A and Part B). This also allows you to sign up for a Medicare Drug Plan.

During the OEP, you cannot: switch to a different Medicare drug plan.

So What is a Special Enrollment Period?

The Special Enrollment Period commonly referred to as a SEP. It is triggered when certain events happen in your life like moving to another State or losing other insurance coverage. The Key point you need to remember is this: you have 60 days to elect new coverage under the Special Enrollment rules. Once the 60-day time frame has expired, the Special Enrollment is OVER, GONE, and not coming back. And note: The Government does not care if you did not know about the 60-day rule.

Pay attention to the 60 day time frame and be careful with your choice. You only get one election period during the Special Enrollment Period. You do not get two or three, you get one chance to elect new coverage due to your life event that created the Special Enrollment Period. So, make it count!

Here are a few examples of Special Enrollment Periods.

  • Moving: But you have to move out of your current service area. The Service area could be your County, or it could be your State. The key thing to remember: You must inform the Social Security office and your current insurance plan or plans that you have a new address. They will tell you if you are required to change plans due to your move.
  • If you lose coverage in the following: You will qualify for a special enrollment if you lose coverage in the following: Medicaid, Extra Help, Coverage at Work, Cobra, Part D Coverage or your Medicare Advantage plan. Note: the loss of coverage must be of no fault of your own. For example, if you plan cancels because you did not pay your bill, that does not qualify.
  • Change in your Status: this means something changed in your life. The following are a few examples. You became eligible for Medicaid, you became eligible for Extra help, you became eligible for a special needs plan, you moved back to the USA after living outside the Country and this one always gets a laugh!!! You just got released from Jail.
  • Five Star Plans: Medicare places a lot of emphasis on customer service and they rate each company with a Star rating system. This star rating system gives you an idea how good or how bad the customer service is with each company. One star is the worse and Five Stars is the best. If a company achieves five stars, Medicare rewards that company and allows them to enroll Seniors in their plan all year long. If you want more information on five-star plans in your zip code, please call my office.

Will you pay a late enrollment penalty if you sign up during a SEP? This is a common question about the special enrollment period. And the answer is NO.

Will you be required to provide proof to get the special enrollment period? The short answer is YES. But the proof will be requested. You do not provide it with your application. Medicare will request the proof through the company you signed up with and you must respond within the required time frame or your plan will be cancelled. So, pay attention to the mail and respond to their request for information.

Life happens. Changes happen. Events can be life-altering but the one constant is that we are here for you. We’ve helped so many of our clients through unexpected changes and we can help you too.

That’s why “We put the CARE in Medicare”. (228) 762-3334.