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Medicare Special Enrollment: Everything you need to know

Special chances to enroll in Medigap, Medicare Advantage or your Medicare Prescription Drug coverage.

by Lisandro Bustos+ on Mar 20, 2019 | 5 Comments

There are special circumstances often referred to as Guaranteed Issuance that will allow you to enroll in Medigap with no health questions asked. You can also modify your Medicare Advantage coverage or your Medicare Part D Drug coverage during this time. These opportunities are called Special Enrollment Periods (SEPs) and they are outlined below:

1) You move

If you had a Medicare Advantage Plan then move, you can usually switch to a new MA Plan or enroll in Medigap with no medical underwriting. You have two full months (63 days for Medigap) to do so.

  • You move to a new residential address that is not in your plan’s service area.
  • Your new address is still in your plan’s area but now you have new options.
  • You moved back into the US after living abroad.

2) You lose your present coverage

If you are Medicare eligible and lose your current coverage you can join a Medicare Advantage Plan or Medicare Prescription Drug Plan during the first two months after you lose coverage. If you enrolled in Part A and B before losing your coverage, you get 63 days to enroll in Medigap. If you only enrolled in Part A before losing your coverage, you get 6 months to enroll in Medigap after losing your coverage. Examples of losing your present coverage include:.

  • You are leaving coverage from your employer.
  • You dropped your coverage in a Program for All-Inclusive Care for the Elderly (PACE).

3) You have the opportunity to get other coverage

In which case you can drop your current Medicare Advantage Plan or Medicare Prescription Drug Plan.

  • You have the chance to enroll in other coverage offered by your employer or union.
  • You enrolled or are enrolling in other coverage as good as Part D like the VA coverage.
  • You enrolled in a PACE Plan.

4) Your plan changes its contract with Medicare

In which case you can enroll in Medigap or switch from your Medicare Advantage Plan or Medicare Prescription Drug Plan to another plan.

  • Medicare sanctions your plan. Your chance to switch varies from case to case.
  • Medicare terminates your plan’s contract. You can enroll or switch in between two months before and one month after your plan is terminated.
  • The contract of your MA, Medicare Prescription Drug or Medicare Cost Plan is not renewed. You can enroll or switch from December 8th to the last day of February.

5) Other circumstances

  • You can leave your Medicare Advantage Plan before 12 months have passed by since you got it, and enroll in Original Medicare. You will have a special chance to purchase a Medigap policy with once again, no health questions asked.
  • If your employee-sponsored retiree plan continues to offer benefits but ends your supplemental coverage. You have two full months to enroll in a Medigap or Medicare Advantage plan.
  • If your Medicare Advantage plan increased your premium or co-payments by 15% or more, reduced your benefits, stopped offering the plan, or ends its relationship with your provider. You have two full months.

Joining or switching Medigap, Medicare Advantage or Medicare Prescription Drug Coverage

Please use our online quote service to find out exactly how much Medigap would cost you! Unfortunately, we are not able to show online quotes for MA or Part D so if you are looking to enroll in these plans please give us a call at 1-800-930-7956. We have helped hundreds of our clients switch to new coverage during special enrollment and there is never a fee for our service.

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Reader Comments and Questions

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By James on August 06, 2019

I am a resident of SD with a birth date of 11/28/1945. At age 65, I elected NOT to enroll in Medicare as I was still working, and still am. I have been CONTINUOUSLY covered by private medical insurance since age 65 through either my employers or my wife's employers plans. My current insurance expires August 31, 2019, when I will retire. Somehow, I got signed up unknowingly for Medicare part A, but I have never used it. Except for taking several inexpensive generic drugs, I am in very good health. Beginning September 1, I will have sold my home and will be RVing full-time and volunteering at various National Park/US Government sites throughout the US. I am looking for the best health plan using Medicare or Medicare Advantage. Plz email me your responses to the above issues and plans you recommend. I may later this week want to talk with you by phone. As of now, I have not contacted any agent about the above. -Jay

Jay,
Looks like you are doing everything right. You almost always should enroll in Medicare Part A when you turn 65. Since you were covered through work you should have postponed Part B as you did.
NEXT STEPS:
1) Enroll in Medicare Part B if you haven't yet with a 9/1/2019 effective date.
2) Contact us to research and enroll in a Medigap, Medicare Advantage and/or Part D coverage. Call us at 1800-930-7956
3) Start RVing!

P.S. We have helped many of our clients who are in similar situations. Our biggest challenge is addressing your permanent address since you will be on the road!
-Chris from Senior65.com


By Denise on August 01, 2019

I will be 70 in 2020. I do have Medicare Part A. Do I have to get Medicare Part B at 70 since I have health insurance through my employment or can I wait until I retire? Thank you.

Denise,
You can wait until you retire. When that time comes you will get a Special Enrollment Period to enroll in Part B, supplemental insurance, drugs or Medicare Advantage.

Give us a call when that time comes. There is never a fee to work with us.
-Michelle from Senior65.com


By Peter on July 17, 2019

Hi, I read all Your Q&A section, I am still confused. I have Simple question:' I am turn in 76 on August 28, 2019. I have Health Insurance with Group insurance by Employer. I have Medicare Part A and Denied Part B since I was 66. Now I want to Have Medigap or Advantage Cover in December 2019, Then I will Drop My Group Insurance. WHAT MONTH IN 2019 I APPLY FOR PART B TO GET MEDIGAP/ADVANTAGE COVER? PLEASE ADVICE. THANKS

Peter,
You want to contact Medicare in August and request a Dec 1st 2019 effective date for part B. Medicare should allow you to pick your Part B start to match when your work coverage ends. Up to three months before your desired date you will be able to enroll in Medigap or Medicare Advantage (MA). Once you have your new Part B effective date, give us a call and we can help you select a Medigap or MA plan.
-Michelle from Senior65.com


By Robert on June 21, 2019

Is there anything special I need to do to temporarily opt out of Medicare till I am 68?

Robert,
If you do not already have Medicare and have credible coverage through work, you can stay on that coverage until you stop working. You will want to check with Medicare to make sure they DO NOT ENROLL you in Medicare Part B. Once you are 68 you can enroll in Medicare Part B. That will trigger a Special Enrollment Period for you to enroll back into Medicare and also Medigap, Part D and Medicare Advantage.

Contact us if you wish to enroll in any of these plans. There is never a fee for our service.
-Michelle from Senior65.com


By Frank on March 27, 2019

So bottomline is if I leave work coverge after turning 65 I have 63 days to enroll in medigap is that correct?

Frank,
After leaving your employer's insurance you will have 63 days to enroll in a Medigap Plan IF you are over 65 and have missed your initial enrollment period.

When you're ready to enroll please give us a call! We can help you at no additional cost to you.

-Michelle from Senior65.com



Have a question not answered above??? Click here

PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.


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