Medicare: Rule Changes for SEPs

SEPs are “special enrollment periods” which allow people to enroll in Medicare supplement or Advantage policies outside of normal open enrollment periods.

SEPs are available for a variety of situations: relocations, loss of insurance through work, if an insurer drops a drug that you need from coverage, etc.

Example: Say you turn 65. You are automatically enrolled in Medicare Part A.  If you don’t enroll in Part B (doctors) or Part D (drug coverage) during that initial enrollment period, you will pay a higher premium for these parts when you go to enroll in the future.

If you have a job with health insurance that meets the Medicare standard when you turn 65, you still get Part A, but you can defer enrolling in Parts B and D. When you leave that job, you have a 60 day SEP to get that coverage without penalty.

On June 19th, CMS will impose new requirements for proving eligibility for an SEP. This may add up to two months for processing requests for new coverage. You may be paying out-of-pocket for any care that you need during that gap. Will Medicare reimburse you later? Probably, but you’ll need to front the money in any case.

There are exceptions to the SEP rules.  Nevada has changed the rules to permit year-round open enrollment for its residents. Congress gave Native Americans year-round enrollment privileges.

If the politicians you elect are so wonderful, why haven’t they done that for you? Perhaps you should ask.

If you need advice as to whether you are eligible for an SEP, call your agent. If you can’t find him, I’ll try to put you in touch with someone who can help you. There are a lot of rules and unless you want to become an expert on the law, this is not a time for DIY.

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