Most people sign up for Medicare hospital insurance (Part A) and medical insurance (Part B) during the Initial Enrollment Period (IEP) when their eligibility begins. The initial enrollment period spans 7 months, starting three months before one turns 65 through the three months after turning 65.

A second chance to enroll for everyone who missed their IEP is during the General Enrollment Period (GEP) that lasts from January 1 to March 31 every year. However, you might have to pay a late sign-up fee if you don’t qualify for a Medicare Special Enrollment Period (SEP).

What is a Special Enrollment Period for Medicare?

The Special Enrollment Period applies to all parts of Medicare and allows people 65 and older to apply for Medicare benefits outside of the IEP and GEP and dodge the late enrollment penalty if specific life events are significant enough to result in an exemption.

These qualifying life circumstances vary from changes in your current health coverage, relocation, modifications in your plan’s contract with Medicare, and other special situations. Depending on what triggers the SEP, you can switch, enroll, or drop your coverage.

What qualifies you for a Special Enrollment Period for Medicare?

You can join Medicare past the standard enrollment schedules on several acceptable occasions. Below are some common instances that qualify you for a Medicare Special Enrollment Period. 

1) You changed your residential address

• Your new home address is out of your plan’s network area;
  
• You lived abroad or volunteered in a foreign country.

2) There are modifications in the current coverage

• You lost Medicaid coverage;
  
• You lost group health coverage after you or a family member left a job;
  
• Medicare changes or terminates your plan’s contract.

3) You were affected by a declared natural disaster or an emergency

4) You have TRICARE

If you’ve missed the enrollment window and are unsure whether you qualify for a SEP, call Social Security to clarify your situation.

How long is the Special Enrollment Period for Medicare?

Each qualifying event has different start and end SEP time frames and rules. 

You have 6 months SEP if:

• You recently lost Medicaid coverage;
  
• You were a victim of a natural disaster or an emergency;
  
• You received inaccurate information about a plan.

You have 8 months SEP if:

• You have an active employer group health plan (EGHP) through your, your spouse’s, or another family member’s employment;
  
• You lost the coverage because you, your spouse, or a family member left the job the insurance is based on.

If you were released from incarceration, the special enrollment for Medicare starts after the month you were released and ends on the last day of the 12th month.

If you experienced a less common qualifying life event or other special situations, call Social Security to verify if you can take advantage of the SEP.

How long is the Medicare Part B special enrollment period?

If an alternative creditable coverage is in effect through employment, you may defer enrollment for Part B. The same exemptions apply to Social Security disability beneficiaries insured under their own or their family’s group coverage.

How do you know if your employer’s plan is creditable?

If there are more than 20 employees in your organization, Medicare will consider your group plan creditable. Otherwise, you will want to enroll in Part B during the IEP.

Note: COBRA and retiree health plans are not considered creditable.

The Medicare Part B special enrollment period application lasts for eight months from the time the group health coverage ends due to you, your spouse, or a family member leaving the job. The Medicare Part B special enrollment period form you must fill out is the CMS 40B. Then, attach an employer-signed CMS-L564 that proves that you have active group health insurance before submitting it to the local Social Security office.

One exception: If the group insurance ends during the 7-month IEP window, you won’t qualify for a SEP. Therefore, if your group coverage is set to end during the IEP, you need to enroll in Part A and Part B.

How long is the Medicare Advantage Special Enrollment Period?

You need to have both Parts A and B to be eligible to enroll in an MA plan or Part C, which you can do during these periods:

• Initial Enrollment Period;
  
• Open Enrollment Period from October 15 to December 7 each year;
  
• Medicare Advantage Open Enrollment Period from January 1 to March 31 each year.

If special circumstances qualify you to make alterations in your plan, you have a 2-month special enrollment period for Medicare Part C. Those circumstances are:

• You relocated to an area that’s out of your plan’s network;
• Your recent home address is still within your plan’s network, but you have new plan options;
• You just moved into or out of a long-term institution (e.g., a skilled nursing facility);
• You lost COBRA coverage or employer-based coverage;
• Medicare has terminated your plan’s contract;
• A federal employee has made a mistake that led you to join or decline an MA plan.

How long is the Medicare Part D special enrollment period?

Most MA plans, like HMOs and PPOs, are often bundled with drug coverage (Part D), so beneficiaries only enroll once to get both. However, you can also get separate drug coverage if your existing Part C plan, like a Medical Savings Account (MSA) or a Private Fee-for-Service (PFFS) plan, doesn’t offer prescription benefits. The enrollment period for Part D is the same as for Part C.

If you didn’t have a Medicare drug plan or creditable prescription coverage for 63 days or more, 1% of the national base beneficiary premium of $32.74 might be added to your monthly payment for every full month that you were uncovered.

You have 2 months special enrollment period for Medicare drug coverage if: 

• You were unaware that you were losing creditable drug coverage;
  
• You were not told that your drug coverage wasn’t creditable;
  
• You’re enrolled in or lose eligibility for the State Pharmaceutical Assistance Program (SPAP), and you lost eligibility.

When is the best time to enroll in Medicare?

Unless you lost your job and can’t simultaneously pay all premiums, the best time to join Medicare is during the initial enrollment period. You don’t risk having a lapse in your coverage, and you can sidestep the lifelong late enrollment penalties. You also get the cheapest premiums when you first become eligible.

However, some life events are inevitable, and enrollment could also slip anyone’s mind. If you join Medicare late, be sure to call Social Security to see if you can qualify for a Medicare special enrollment period. 

Ready to enroll in Medicare? Read this guide on how to get started in Medicare in 2023.