Retroactive Entitlement SEP: When Medicare is Late Processing Your Medicare Enrollment

retired couple at a computer learning about retroactive election period for medicare

When you first become eligible for Medicare and apply for Part A and B, it is a possibility that there may be delays with CMS processing your application. In some cases, these delays can cause your Medicare card to get to you after the effective date you chose for your Medicare coverage to begin, which will prevent you from being able to enroll in a plan. If this were to happen, you will qualify for what’s known as a retroactive entitlement special election period (SEP).

In the following blog we will cover

What is the Retroactive Entitlement?

The Retroactive entitlement SEP is for individuals who have not been provided the opportunity to enroll in a plan during their ICEP/IEP, perhaps due to administrative delays. These individuals will have an SEP to enroll in a plan that begins the month the individual receives the notice of Medicare entitlement retroactive determination and continues for two additional months after the month the notice is provided. The effective date for the plan would be the first of the month after the application is received by the plan sponsor.

When the SEP applies

Ruth is newly eligible for Medicare and turns 65 on August 4th. In July, Ruth decides to enroll in Medicare Part A and Part B to be effective August 1st. Due to an influx of Medicare enrollments, CMS doesn’t process Ruth’s application for 90 days and she doesn’t receive her Medicare card by the August 1st effective date. Because Ruth didn’t have her Medicare card in time, she missed her opportunity to enroll in a plan, but she would qualify for the retroactive entitlement SEP.

How does it work?

When Ruth finally receives her Medicare entitlement retroactive determination notice and Medicare card in October, she chooses to enroll in a Medicare Advantage plan that will become effective November 1st. Keep in mind, her Medicare Part A and B will be retroactive to the original August 1st effective date, but her Medicare Advantage plan, Part D Prescription Drug Plan or Medicare Supplement will not be effective or cover any services provided prior to November 1st.

Medicare can be confusing and trying to make sense of special election periods can make things even more difficult. Don’t do it alone! Our friendly licensed agents are here to help you navigate the process. Contact us today for unbiased no fee assistance!

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