How to Use Medicare's Special Enrollment Period - dummies

How to Use Medicare’s Special Enrollment Period

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So if you’ve delayed Medicare Part B enrollment beyond age 65 because of current employment (either your own or your spouse’s), how does the special enrollment period (SEP) work?

In essence, this SEP comprises two quite different time periods. You can actually use it

  • At any time while you or your spouse is still working — between the end of your initial enrollment period at age 65 and the time when you or your spouse stops work or loses your employer coverage

  • For up to eight months after this employment or coverage has ended

In other words, your absolute deadline for enrolling in Part B without penalty in this situation is the end of that eighth month. For example, say you’re 69 years old and retired but are covered under your spouse’s health insurance at work. Your spouse’s last day of work is March 15. Your special enrollment period begins on the first day of the following month, April 1, and ends eight months later on November 30.

Whenever you choose to sign up for Part B — whether you’re still covered by employer health benefits or are in that eight-month grace period — your Part B coverage begins on the first day of the month after you enroll. Of course, you can time your enrollment so that Part B kicks in as soon as the employer insurance ends to ensure you have no gap in coverage.

At the same time, you can sign up for Part A (if you haven’t already done so), for Part D prescription drug coverage, or for a Medicare Advantage health plan, according to your preferences. (You don’t have to wait for any other enrollment period.)

If you choose to buy Medigap supplemental insurance, you get full federal protections when you purchase a policy within six months of enrolling in Part B. Here are some examples of how this SEP works in different situations:

  • Dan is 85 years old, but he’s only just beginning to think about signing up for Medicare Part B. That’s because his wife, Lily, is 15 years younger than he is, and he’s been covered on her health insurance from work since he turned 65.

    Now Lily is about to retire at age 70, and both of them will be applying for Part B together, using their SEP. To avoid any break in coverage, they’ll both enroll during Lily’s last month at work and start receiving Medicare benefits on the first day of the following month.

  • Eduardo continued to work after age 65, and his employer’s health benefits covered both him and his 66-year-old wife, Rosa. But these benefits came with a hefty monthly premium and a high annual deductible, and after a few years they decided that Medicare would be more affordable. The couple was free to sign up for Medicare at any time while covered under the employer plan.

    So when the company’s open enrollment came around, they opted out of that plan and its coverage terminated at the end of the year. They enrolled in Medicare in December and their new coverage began January 1.

  • Margaret was 68 when her job was downsized. Her hours were reduced from full time to part time, and consequently she lost her company health benefits. But the SEP enabled her to enroll in Medicare before those benefits came to an end on May 31, so her Medicare coverage began June 1.