Medicare SEP Rules

By Ed Crowe | General Articles | 0 comment | 1 August, 2023 | 0

Medicare SEP Rules – Medicare Part B Special Enrollment Period Rules

Every agent knows about the Annual Enrollment Period (AEP). It’s often the busiest time of the year and it is when the majority of prospective clients are enrolled in insurance plans. There are, however, exceptions. Special Enrollment Periods, often known as SEPs, are periods of time outside of the AEP when someone can enroll in health insurance. These SEPs are usually prompted by a specific change in personal circumstances. For Medicare Part B, or medical insurance, SEPs are necessary because Medicare Part B is optional, while Part A (hospital insurance) is not. What are the Medicare SEP rules?

When Does It Start?

The Part B Special Enrollment Period starts when a person has coverage from their employer (called job-based insurance) and is simultaneously in their first month of eligibility for enrollment in Part B. The SEP ends eight months after the person loses coverage from that employer, either by end of coverage or unemployment. If they enroll in Part B coverage during their Special Enrollment Period, then the beneficiary can avoid paying the Late Enrollment Penalty (LEP), as well.

In most cases, it would be recommended to enroll in Medicare before the person loses their job-based coverage in order to avoid gaps in healthcare. It is important to understand the SEP rules.

How Do I Enroll? – SEP Rules

There are two steps to enrolling in Medicare Part B during the SEP.

Contact the Social Security Administration (SSA)

The SSA can be reached at 800-772-1213. The prospective beneficiary can then request forms. The forms they will need to fill out are CMS 40B (application to enroll in Medicare) and CMS L564 (request for employment information). Both of these are needed to complete the process. However, the beneficiary should fill out CMS 40B and their employer should fill out CMS L564. If there are multiple employers, each one should receive a copy of the CMS L564 to fill out.

Submit all forms to the SSA

Once all the information has been gathered, the forms must be dropped off either at a local SSA office or they can be sent to the mailing address. Locating a local SSA office or their mailing address can be done at their website.