To which circumstances does the 8 month Special Enrollment Period (SEP) apply to?
- Enrolling into part B original Medicare
- Enrolling into a part D plan
- Enrolling into an MAPD plan
Some have come to believe it’s all of the above but that’s not correct. Now, there is a reason why some believe this to be the case and the reason is not surprising at all.
To get straight to the point, the 8 month SEP applies to enrolling into original Medicare part A and/or B when someone disenrolls from a commercial group policy. In the Medicare & You book it states the following on page 23 under the heading Special Enrollment Periods: “If you (or your spouse) are still working, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were
first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or if you’re disabled, a family member’s), you can sign up for Part A and/or Part B:
■ Anytime you’re still covered by the group health plan ■ During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first“.
So if we follow this scenario a bit further one would could ask, “when can someone enroll into an MAPD plan if they enrolled into part B using the 8 month SEP?”
The answer is simple, they must apply for the MAPD plan before the part B becomes effective. Here is the “Gotcha!”, if you wait until after part B becomes effective you’ve lost your SEP window to enroll into the MAPD plan. If you don’t qualify for another SEP you would have to wait until the Annual Enrollment Period (AEP) to apply. Let’s use an example to clarify this statement.
Say Mrs. Smith became eligible for Medicare part A and B in August 1st 2015 and chose not to enroll into part B and instead keep her group coverage. Effective January 1st 2017 she decides to retire and thus her group coverage ends 12/31/2016. She was unaware that she could enroll into Medicare part B right after her group coverage ended and so unintentionally delays it an additional four months. But that’s ok, in April she applies for Part B using her SEP (8 month SEP) and is approved for it to become effective May 1st. Now here is the tricky part, before her Part B becomes effective she’s able to apply for an MAPD plan to be effective May 1st. During the month of April she must submit an application for the MAPD plan, if she were to wait until May to apply she would be denied for not having a valid enrollment period.
There are some exceptions to this enrollment deadline, for example if someone were to qualify for another SEP (e.g., LIS, Medicaid), they would be eligible to apply for an MAPD plan every month.
So remember if you delay part B enrollment you must enroll into an MAPD plan before your part B becomes effective otherwise you’ll likely be waiting for the AEP to get another chance to enroll.
There you have it, the 8 month SEP is for Original Medicare after losing group coverage. Oh and if I left you wondering why so many confuse this Medicare SEP with others, well it’s simple: it’s Medicare and it’s all very confusing.