3 Medicare Special Election Periods You Probably Didn’t Know About

Medicare special election calendar

Most people on Medicare have one time per year that they can add, change, or drop a plan; during Medicare’s Annual Election Period. Generally, you cannot make a change outside of this period unless you have special circumstances that opens up a Special Election Period (SEP). Medicare has many SEPs for various circumstances that many beneficiaries do not know about. In this blog we cover three election periods that you probably didn’t know about.

Lawfully Present Special Election Period

Government Disaster Special Election Period

Disenroll Due to Gain or Maintaining Other Creditable Prescription Coverage

Lawfully Present Special Election Period

If you have become lawfully present in the United States, understanding the process of enrolling in Medicare is important to ensure you receive your healthcare. When a non- U.S. citizen becomes lawfully present in the United Stated they may enroll in a Medicare Advantage or a Prescription drug plan by using the special election period for someone who becomes lawfully present. This special election period would start the month you receive lawful presence status and ends once you enroll in a plan or two months after you receive lawful presence status, whichever comes first. Once you receive lawfully present status and are eligible for Part D you will need to enroll in a Part D prescription drug plan or have other creditable coverage within 63 days of becoming eligible otherwise you will be subject to the Part D late enrollment penalty.

Example: When Sammy came to the United States in March as a non-U.S. citizen, he became lawfully present by obtaining a green card effective in May. He is 68 years old and looking for healthcare coverage. Now that he is considered lawfully present, he has the option to enroll in a Medicare plan with an SEP and is required to begin Part D coverage within 63 days. He will not have any late enrollment penalty as long as he begins his coverage before the 63 days are up!

CMS will be able to determine if an individual is ineligible or not for enrollment based on their lawful presence status. The special election periods cover a lot of different situations! Our licensed agents are happy to go over your information and verify if you qualify for the election period. Please call our office at 480-821-9188 and we can help you navigate your qualifying election period and enrollment.

Government Disaster Special Election Period

In times of unexpected government disasters and emergencies, understanding the Medicare Special Election Period for Government disasters is important. This election period is for beneficiaries who need to enroll or disenroll from Medicare health and prescription drugs plans but missed an election period due to a government declared emergency in their area. You can use this election period to sign up for a Medicare Advantage plan, switch MAPD plans, return to original Medicare, sign up for a Part D plan, or drop a Part D plan.

Example: Mr. Bates recently became Medicare eligible. He lives in Arizona and has been out of town due to the wildfires near his home. He missed his initial election period due to the emergency. The state government declared the fire as a disaster. Mr. Bates can use a Special Election Period for the duration of the disaster as well as two months after the disasters date ends. Once he makes a plan election it will be effective the first month after the application is approved.

The FEMA website has a tool to search online in your area to check if you live in a county where you may qualify for a special election period due to a declared emergency. If you do live in a county where an emergency has been declared or rely on someone for help with healthcare that lives somewhere an emergency has been declared, our licensed agents can help you submit an application by using the specific special election period.

Gain or Maintaining Other Creditable Coverage Special Election Period

As a Medicare beneficiary you should have prescription drug coverage that is considered creditable coverage to avoid any penalties. This would mean you are enrolled in a plan than offers drug coverage that is at least as good as or better than Medicare drug coverage. You may have enrolled in a plan that provides prescription drug coverage such as a MAPD or PDP plan when are eligible for other creditable coverage like VA or TRICARE.  If so, then you are eligible for a special election period to disenroll from the Medicare Advantage Plan with Prescription drug coverage (MAPD) or from the stand-alone Prescription drug plan (PDP). You can use this SEP whenever you are able to enroll in other creditable coverage.

Example: Arthur is a Veteran that is eligible for Veterans Affairs benefits and has been on Medicare since 2013. When Arthur enrolled in Medicare he was not aware that he had any VA benefits and enrolled in a Prescription Drug Plan that has an $82 monthly premium. When Arthur met with an agent to explore ways to lower his monthly health care costs, he found out that he was eligible for VA Benefits and could be getting his prescriptions through the VA. Because he has other creditable coverage, Arthur has the option to disenroll from his current Part D Prescription Drug plan immediately.  He does not have to wait until the Annual Election Period to make a change. His agent was able to help him disenroll from his current plan.  He no longer has a $82 monthly premium since he uses his VA health coverage for his prescription drug needs.

When going over your health care coverage and cost we know there is a lot of information to understand! Meeting with an agent to go over your unique situation is a great way to ensure you are making the right decisions.

Our licensed agents are happy to go over your current plan at no cost to you and discuss things like special election periods and creditable coverage. Please feel free to call our office a 480-821-9188 and speak with an agent today.

Sources:

www.medicare.gov

https://www.cms.gov/files/document/hpmsannouncementmemonovember202190nlpfinal.pdf

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