Medicare Special Enrollment Period

Medicare Special Enrollment Period

There are cases where an individual may enroll in Medicare outside of regular enrollment periods due to extenuating circumstances. This is known as the Medicare Special Enrollment Period (SEP). If you qualify for the Medicare Special Enrollment Period, you can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP).

If you are 65 or older and are covered under a group health plan, either from your own or your spouse’s current employment, you have a Special Enrollment Period during which you can sign up for Medicare Part B. This means that you may delay your decision to enroll in Medicare Part B without having to wait for the General Enrollment Period and without having to pay the 10% premium penalty for late enrollment.

Most people get Medicare Part A without paying a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes. However, if you don’t have enough work history to get premium-free Medicare Part A and delay Medicare enrollment when you turn 65 because you have employer-sponsored coverage, you can also use your Special Enrollment Period to sign up for Part A. Otherwise, a late-enrollment penalty could apply for Medicare Part A if you don’t enroll when you’re first eligible and need to pay a premium.

Under such circumstances, you may:

  • Enroll in Medicare Part A and/or Part B any time while you’re covered under the group health plan based on your current employment.
  • Enroll in Medicare Part A and/or Part B during the eight-month period that begins with the month your group health coverage ends or the month your employment ends, whichever comes first. Medicare Special Enrollment Period rules do not apply if employment or employer-provided group health plan coverage ends during your Initial Enrollment Period.

If you do not enroll in Medicare by the end of the eight-month period, you will have to wait until the next General Enrollment Period, which begins January 1 of the next year. You also may have to pay a higher premium for Medicare Part B. If you don’t qualify for premium-free Medicare Part A, you may owe a late-enrollment penalty for Part A as well.

People who receive Social Security disability benefits and are covered under a group health plan, from either their own or a family member’s current employment, also have a Medicare Special Enrollment Period. For more information on situations that may qualify you for a Special Enrollment Period, contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; TTY users can call 1-877-486-2048.

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This book helps you learn about the different parts of the Medicare program, including Medicare Part A and Part B (together, they are often called “Original Medicare”), Part C (often called “Medicare Advantage”) and Part D (the part of Medicare that covers your prescription medications).

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This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Florida Health Agency is a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.

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