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Medicare Part B Special Enrollment – Complete Guide

HMT News TeamHMT News Team  February 15, 2022

Medicare offers many plans, and each has a role to play. There is a program suited for whatever benefits you need. Whether it be coverage on medical conditions such as end-stage renal disease to eye examinations. Of course, the benefits you receive rely on the program you enroll in. 

There are four parts to Medicare, Part A, Part B, Part C, and Part D. Parts A and B are covered under Original Medicare, and Parts C is also known as Medicare Advantage. Part C includes both the benefits of A and B and extra services. Part D can stand alone or be included in your current plan.

Special enrollment for Part B covers different situations than the previous ones offer. It is more so related to job-based insurance. 

What is Medicare B Special Enrollment?

For short, special Enrollment Periods, SEPs are periods outside the normal enrollment periods when you can enroll in health insurance. These periods are usually based on certain circumstances.

Special Enrollment Periods for Part B begins when you have coverage from your current work (job-based insurance), and you are in your first month of eligibility for Part B. It will end eight months after losing coverage from your current place of employment due to either the coverage ending or the employment.

You can use the Part B Special Enrollment Period with job-based insurance. You can use it for eight months after no longer having job-based insurance as well. 

When it comes to the difference between open enrollment and special enrollment, open enrollment has an annual window where you can enroll. Special enrollment is when you can enroll for coverage outside of the yearly window depending on if the circumstance is acceptable. 

Do I Qualify for Medicare Special B Enrollment?

Medicare Part B Special Enrollment - Person at doctor office | Healthier Me Today

To qualify for Part B Special Enrollment Period, you would have had to be continuously covered by insurance from your current work or by Medicare Part B. Therefore, when you become eligible for Medi, care includes the first month you became Medicare-eligible. 

If you have more than eight ongoing months without any coverage from either current work or Part B, you are not eligible for the Part B Special Enrollment Period. 

The qualifications needed for Part B Special Enrollment Period are if there have been certain life events such as moving, getting married, loss of health coverage, having a baby, or adopting a child. Depending on your Special Enrollment Period type, you will be given 60 days before or 60 days after the live event has happened to enroll in the plan.

The main basic types of life events that will qualify you for the Special Enrollment Period are the following four circumstances:

  • Loss of health coverage includes losing existing health care coverage, including job-based, student plans, or individual coverage, turning 26 and losing coverage through a parent’s plan or losing eligibility for Medicaid, Medicare, or CHIP.
  • Changes in residence. Moving to a different ZIP code or country, moving to or from a shelter and other transitional housing, a seasonal worker moving to or from the place they both live and work, and being a student moving to or from their school.
  • Changes in your household include having or adopting a child, death in the family, getting married, or getting divorced. 
  • Other qualifying events can include; becoming a U.S. citizen, leaving incarceration, AmeriCorps members starting or finishing their service. Also, changes in your income will affect the coverage you qualify for and gain membership in a federally recognized tribe or status. 

What Makes Special B different from Other Medicare Enrolments?

Medicare Part B Special Enrollment - female nurse | Healthier Me Today

Medicare works on an open enrollment basis, which means that people can enroll at a certain time during the year. The general enrollment period starts from January the first and ends March the 31st every year. The initial enrollment period is seven months when someone is first eligible for medicare. This period will begin three months before you turn 65, including the month you turn 65 and ends three months after turning 65. 

Open enrollment is based on fixed dates and periods that a person can enroll. Although these periods are fixed, there isn’t only a one-time frame, but a few cater to certain eligibility. Special Enrollment Period is an opportunity to enroll in Medicare outside the Initial and the General Enrollment Periods. Those who are eligible based on their disability could meet the criteria for the Special Enrollment Period based on their spouse’s current employment. 

People who didn’t enroll in Medicare when first eligible due to their spouse or themselves still working and having employer-sponsored Group Health Plan coverage based on the employment. They can enroll in the Special Enrollment Period.

Medicare Part B Special Enrollment Period Pro’s

Medicare Part B Special Enrollment Period is a grace period given to those who undergo life-changing events and have missed the Initial Enrollment and the General Enrollment period or need to enroll suddenly for an unplanned event.

  • You do not have to wait to enroll during the initial and general enrollment periods.
  • It gives you the chance to change your current Medicare coverage plan if certain life events happen.
  • You may have found another program you would like to enroll in 
  • If you lose the State Pharmaceutical Assistance Program, you can use SEP to enroll in another program to maintain the coverage.

A Second Chance

The Medicare Part B Special Enrollment Period is almost like a saving grace to those with unforeseen circumstances. It allows for a second chance. While having no annual enrollment period can provide a safety net for those who qualify. For example, making it possible for people who recently found a specific program they didn’t have the chance to enroll in during the General Enrollment Period or the Initial Enrollment Period.

HMT News Team

HMT News Team 

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