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Special Enrollment Period

Special Enrollment Periods (SEPs) allow you to enroll in Medicare at any time without any late penalties. It is for individuals who have recently retired, have a chronic health condition, have Medicaid, or experience outstanding circumstances.

SEP for Retirees

Not everyone retires right at age 65. If you’re still working when you’re eligible for Medicare, you can delay your enrollment. Not everyone does this—oftentimes, people choose to have both group/employee health insurance as well as Medicare.

But, if you decide against that and wait till you retire for Medicare, you will not have any late penalties and can enroll using a SEP within 8 or so months after your group health plan officially ends.

SEP for Chronic Conditions and Disability

SEPs are also available to those who contract or develop a chronic illness/condition. Once your health status is confirmed by your doctor, you can contact the Medicare offices and sign up. You may also be automatically enrolled.

This also applies if you have a serious disability. After receiving 24 months of Social Security disability insurance, you should be automatically enrolled under a SEP regardless of age.

SEP for Medicaid Recipients

If you are not enrolled in Medicare when eligible for financial reasons, you may be eligible for Medicaid, a government financial program that provides monetary assistance, and helps you get healthcare coverage. Medicaid enrollment may mean that you can use a SEP to also enroll in Medicare.

Having both Medicare and Medicaid is referred to as a Dual-eligible Special Needs Plan (D-SNP). And, if you have a chronic condition as mentioned above, you would qualify for a Chronic Special Needs Plan (C-SNP).

Other Circumstances for a SEP

There are a few other opportunities where you are eligible to add or make changes to your Medicare coverage. These qualifying circumstances include:

  • Moving out of your plan’s service area.
  • You or your spouse are currently working.
  • Making necessary changes to your current plan.
  • Your plan makes changes to your coverage.
  • You’re enrolled or lost a State Pharmaceutical Assistance Program.
  • You must be enrolled or are enrolled in a Special Needs Plan.
  • An error occurred on behalf of your plan provider or a federal employee.

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Enroll in Medicare with My Healthcare Direct

Think you may qualify for a SEP? Ready to enroll in Medicare? My Healthcare Direct can help—call us today at (888) 959-1028.

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