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Medicare Special Enrollment Period

What is the Medicare Special Enrollment Period?

The Medicare Special Enrollment Period is a period in which you can enroll in Medicare or change your Medicare plan based on special circumstances. If you meet the criteria, you may be eligible to enroll in Medicare or change your current Medicare plan.

What Makes You Eligible for the Medicare Special Enrollment Period?

In order to be eligible for premium-free Part A, you must be age 65 or older, and you or your spouse must have worked and paid Medicare taxes for at least 10 years.

You have the ability to receive Part A at age 65 without paying a premium if:

  1. You or your spouse had Medicare covered by government employment
  2. You are receiving retirement benefits from Social Security and/or Railroad Retirement Board
  3. You are eligible to receive Social Security and/or Railroad benefits but you have not yet filed for either
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After you or your spouse’s employment or health coverage ends (whichever happens first), you have the ability to enroll in Medicare Parts A and/or B with the Special Enrollment Period. This is only if you meet the other requirements.

What Specifically Makes You Eligible for Special Enrollment?

The following are a few ways in which you can become eligible for a Medicare Special Enrollment:

  • You move to a new location
    1. You have recently moved to a new address that is no longer in your plan’s service area.
    2. You moved back to the U.S. after living outside of the country.
    3. You just moved into, currently living in, or moved out of a long-term care facility.
    4. You were released from incarceration.
  • You lose your current coverage
    1. You have left the coverage from your employer or union (including COBRA coverage).
    2. You are no longer eligible for Medicaid.
    3. You had drug coverage through a Medicare Cost Plan, but then you left the plan.
  • You have a chance to get other coverage
    1. You have the opportunity to enroll in other coverage offered by your employer or union.
    2. You enrolled in the Program of All-inclusive Care for the Elderly (PACE) plan.
  • Your plan changes its contract with Medicare
    1. Medicare terminates your plan’s contract.
    2. Your Medicare Advantage, Prescription Drug or Medicare Cost Plan’s contract with Medicare are not renewed.
  • You qualify for Extra Help when paying for Medicare Prescription Drug coverage
  • A Five-Star Special Enrollment Period Exemption
    1. During this time, you have the opportunity to withdraw from your Medicare Advantage Plan or Medicare Part D plan to enroll in an open Medicare Cost Plan that has a five-star rating.
  • You are eligible for both Medicare and Medicaid
  • You have a severe or disabling condition which makes you eligible for the Medicare Chronic Care Special Needs Plan
    1. You have Diabetes, Chronic Obstructive Pulmonary Disease (COPD), End-Stage Renal Disease, Lou Gehrig’s disease or a heart condition.
  • You have a Special Needs Plan (SNP) and no longer have the condition that qualifies as a special need.

For more instances, please call our licensed agents 1-800-991-4407 Monday-Friday from 10am to 8pm EST.

What is a Five-Star Special Enrollment Period?

Medicare will use information from member satisfaction surveys and health care providers to give the overall performance star ratings of plans yearly. It uses a five-star rating, with one being the worst, and five being the best.

Why are these ratings made? These ratings are made because it helps you as the customer compare plans based on their quality and performance. The ratings are updated every year. You are only able to switch to a five-star Medicare Prescription Drug Plan if it is available in your area. As stated above, you can also withdraw from your current Medicare Advantage or Prescription Drug plan to enroll in an open Medicare Cost Plan that has a five-star rating. A Medicare Cost Plan is known to be part of the Health Maintenance Organization (HMO) Plan.

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If you have questions about whether or not you qualify for a Medicare Special Enrollment Period, call us at: 1-800-991-4407 / TTY 711

One of our licensed insurance agents will be more than happy to help you with you identifying your eligibility.