Do I Qualify For The Medicare Part B Special Enrollment Period
You qualify for the Part B SEP if:
- you are eligible for Medicare because of your age or because you collect disability benefits.
- you had Medicare Part B or current employment-based health coverage in the month you qualified for Medicare and
- less than eight months have elapsed since you didnt have either current job-based group health coverage or Medicare Part B.
Some people may need to use the Part B SEP if theyre still working. Youll want to sign up for Part B if your employer has less than 20 employees. This is because your employer plan pays only after Medicare does. If you dont enroll in Part B, your employer plan will pay less for your care or nothing at all when it finds out youre Medicare-eligible. If your employer has more than 20 employees, you dont have to take Part B as long as youre still working, but a small number of people do enroll to lower their out-of-pocket costs.
You have to take Part B once your or your spouses employment ends. Medicare becomes your primary insurer once you stop working, even if youre still covered by the employer-based plan or COBRA. If you dont enroll in Part B, your insurer will claw back the amount it paid for your care when it finds out. At that point, you would need to enroll in Part B, but might no longer qualify for the SEP if you delayed enrolling for more than 8 months.
Exact Answer: Up To 30 Days
The Medicare application can be applied to online websites. The application process is quite easy. The process of application will not ask for many documents in major steps. The applicants may not have to sign in any documents while applying for the Medicare part B. The application doesnt charge any fees from the applicant.
The process of the applicant will not take a lot of time, but you have to fill in the details correctly. After the application is completed, then the applicant would be able to check the application status anytime.
When Does My Coverage Start
When and how you enroll for a Medicare plan impacts when your coverage begins. Your benefits may not start until three months after you apply.
If you have not received an acceptance letter 45 to 90 days after submitting your application, call the Social Security Administration or check online. You will need your Medicare application number to do so.
Once your coverage begins, you do not need to reapply each year for Medicare benefits.
However, you will have an opportunity to change plans or adjust your coverage during the open enrollment period, which runs from Oct. 15 to Dec. 7 each year.
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When Will I Receive My Medicare Card
Once enrolled, youll receive a red, white, and blue Medicare card. This provides your Part A and Part B benefits.
If you are automatically enrolled in Medicare, your card will arrive in the mail two to three months before your 65th birthday.
Otherwise, youll usually receive your card about three weeks to one month after applying for Medicare.
Your Medicare card will display:
- Your name
- The Medicare plans youre enrolled in
- Start dates for each plan
If you enroll in a Medicare Advantage plan, youll receive a second ID card for these benefits.
Youll also receive a separate card if you sign up for a standalone Part D plan.
Who Qualifies For Medicare Extra Help
You will automatically qualify for Medicare Extra Help if you have Medicare and also meetany of these conditions:
You have full Medicaid coverage.
You use a Medicare Savings Program to help pay your Part B premiums.
You get Supplemental Security Income benefits.
To learn more about whether or not you qualify for Medicaid, check our state-by-state guide to Medicaid.
If you donât qualify for Extra Help based on the criteria above, you may still qualify if you are at least 65 years old, live in the U.S., have Medicare Part A and Part B, and your annual income is within the annual income and total asset limits.
Income and asset limits are based on the federal poverty guidelines . The poverty guidelines change each year, so make sure to check again around February or March. Below are the Medicare Extra Help income and asset limits for 2019, sorted by filing status.
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Medicare Extra Help for single people
Income up to or at the federal poverty level: $0 deductible, $1.30 copay for generic drugs, and $4.00 copay for brand-name drugs up to the out-of-pocket threshold $0 for either drug type above the out-of-pocket threshold
Income up to or at 135% of the federal poverty level and resources greater than or equal to $9,360: $0 deductible, $3.70 copay for generic drugs, and $9.20 copay for brand-name drugs up to the out-of-pocket threshold $0 for either drug type above the out-of-pocket threshold
Income below 150% of the federal poverty level and resources below $14,160: $92 deductible, $3.70 copay for generic drugs, and $9.20 copay for brand-name drugs up to the out-of-pocket threshold 15% coinsurance for either drug type above the out-of-pocket threshold
Medicare Extra Help for couples
If you make 150% of the FPL or more, then you don’t qualify for Medicare Extra Help.
What Doesnt Medicare Part B Cover
Medicare Part B doesnt cover every possible medical expense. Heres a partial list of what Part B doesnt generally cover.
- Hospital inpatient care, such as a semi-private room, meals, and more. These are usually covered under Medicare Part A. Doctor visits in the hospital may still be covered under Part B.
- Some tests and services that your doctor might order or recommend for you. If your doctor wants you to have lab tests, or any services beyond your standard annual wellness visit, you might want to ask whether Medicare covers them. Medicare Part B might cover some of these services.
- Routine dental care
- Routine vision care
- Most prescription drugs you take at home. Medicare Part B may cover certain medications administered to you in an outpatient setting.
- Hearing aids
- 24-hour home health care
- Long-term care, such as you might get in a nursing home. If the only care you need is custodial, meaning help with tasks such as bathing and dressing, Medicare doesnt generally cover it.
Some of these services, such as routine dental and vision care, might be covered under a Medicare Advantage plan.
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When Will My Medicare Coverage Start
When you choose to apply for Medicare will affect your effective date.
Understanding when your Medicare Part A and Part B will be effective is key to coordinate cancellation of your current insurance and enrollment into Medicare Supplemental Insurance plans.
While most people will be automatically enrolled in Original Medicare, those who are born on the 1st of the month or those who enroll themselves can have different Medicare effective dates. You can calculate your enrollment dates here.
What If An Employer Gives Me Money To Buy My Own Health Plan
A note about individual coverage: youll qualify for an SEP if you delayed Part B because you had employer-sponsored coverage through a group health plan . This is a specific type of insurance plan sponsored or run by your employer. It includes coverage your employer offers you through an insurer, and plans purchased from the Small Business Health Options Program marketplace.
Instead of offering GHP coverage, some employers provide you money to buy your own health insurance. They can reimburse you directly, in which case the money is taxed, or through a Qualified Small Employer Health Reimbursement Arrangement or an Individual Coverage Health Reimbursement Account . Coverage you buy on your own does not qualify you for the Part B SEP even if an employer paid for some or all of it. If you have individual coverage, you should sign up for Medicare when youre first eligible, and can enroll during your initial enrollment period or the general enrollment period.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh worked on federal and state health insurance exchanges at the technology firm hCentive.
Contributions to healthinsurance.org and medicareresources.org represent only his own views.
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How Do I Sign Up For Medicare Part B If I Already Have Part A
If you are already enrolled in Medicare Part A and you would like to enroll in Part B under the Special Enrollment Period , you can apply online at Apply for Medicare Part B Online during a Special Enrollment Period. You can upload your application and documents that verify your group health plan coverage through your employer.
You can also fax or mail your completed CMS-40B, Application for Enrollment in Medicare Part B and the CMS-L564, Request for Employment Information enrollment forms and evidence of employment to your local Social Security office. If you have questions, please contact Social Security at 1-800-772-1213 .
Note: When completing the forms CMS-40B and CMS-L564:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employer’s signature.
- Also submit one of the following forms of secondary evidence:
- Income tax returns that show health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Why Would I Be Disenrolled From Medicare Plan B
Medicare may disenroll a person for non-payment of premiums. A person may also disenroll themselves by leaving the plan voluntarily.
Because adequate healthcare coverage is important, the State Health Insurance Assistance program can help a person make informed decisions about Medicare coverage, including looking at different options to Part B.
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How Much Does Part B Cost
The Social Security Act sets out the Medicare premiums, deductibles, and copays each year.
An individualâs income determines what they will pay for their Medicare Part B monthly premium. For individuals with an income below $88,000, the standard premium is $148.50 in 2021, with an annual deductible of $203.
When To Sign Up For Medicare Part B
If youre retiring, the best time to enroll in Part B is during your Initial Enrollment Period. For those still working past 65, check with your health administrators whether your employer coverage is creditable.
If it is, you can enroll in Part B when you retire or leave your group health plan. Youll be eligible for a Special Enrollment Period when you can enroll without any penalties. If your group health plan is not considered creditable coverage, then you should register for Part B during your Initial Enrollment Period.
If you missed your Initial Enrollment Period, the next enrollment window you can enroll in Part A and Part B is the General Enrollment Period.
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Canceling Part B Because You Cant Afford The Premiums
If you dont have a job with creditable health care coverage but still dont want to pay Part B premiums, use caution. Without health insurance thats as good or better than Medicare, you could start racking up late-enrollment penalties the longer you go without coverage. If you decide to re-enroll in Part B later, these penalties could make your premiums even less affordable.
If you can’t afford your Part B premiums, consider other options before canceling your coverage. You can apply for Medicaid coverage if you’re in a low-income household or have few assets. Medicare also offers several savings programs, which help qualified individuals pay their Medicare expenses.
What Are The Two Enrollment Methods
If youre already getting Social Security or Railroad Retirement Board benefits, you dont need to enroll in Medicare. Youll automatically get Original Medicare as of the first day of the month you turn 65.
Those who are automatically enrolled will receive a Welcome to Medicare packet, which will include your Medicare card, three months before turning 65.
If you want a Medicare Supplement Insurance policy.
If you decide you dont want Part B, you must return the Medicare card. If you keep the card, you keep Part B coverage and you will be charged the monthly premium.
Note that if you live in Puerto Rico, you will only receive Medicare Part A automatically. You need to call Social Security at 772-1213 or TTY 325-0778 to apply for Part B if you want it.
You will not get Medicare automatically if you are not already receiving benefits from Social Security or the Railroad Retirement Board, even if youre close to age 65. You need to apply for Part A and Part B if you want them using one of the methods mentioned here, even if youre eligible for premium-free Part A.
The government expects you to know when to enroll. Be sure to apply for Part B during your Initial Enrollment Period unless you have current employment-based insurance coverage elsewhere. If you dont apply and sign up later, you will have to pay a Part B late enrollment penalty for as long as youre enrolled in Part B.
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What Assets Are Included
Your assets include money that you have across all types of savings accounts, checking accounts, and investment accounts. Make sure to consider your retirement accounts like an IRA or 401, as well any stocks or bonds you own. Real estate that you own other than your primary residence also counts toward your total assets in most cases.
Your assets do not include your home, a car, a burial plot, furniture, or any other personal items. Life insurance policies are excluded and you can subtract $1,500 per person for burial expenses. You donât have to include any advance tax credits you get, such as for the earned income tax credit, or money you received for housing assistance. You can find a complete list of exemptions on the SSA website.
It Pays To Enroll On Time
If you miss your initial enrollment window to sign up for Medicare, you can do so later on. But know this: For each 12-month period youre eligible for coverage but dont apply, youll risk a 10% surcharge on your Part B premiums.
If youre still working during your initial enrollment period and have group health coverage, youll get a special enrollment period to sign up for Medicare later on, and you wont have to worry about that penalty. But otherwise, enrolling on time can not only save you money, but ensure that you have coverage when you need it.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.
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How To Enroll In Medicare Online
To be clear, you dont have to sign up for Medicare online. You can do so over the phone or in person, but if youre looking to save time, completing an online application is probably the best way to go.
The first step in enrolling in Medicare online is creating an account on the Social Security Administrations web site. You do not need to sign up for Social Security at the same time as Medicare, so if thats not your plan, worry not. Youll be asked whether you wish to enroll in one program or both during the signup process.
Next, youll need to provide some basic information like your name, address, and telephone number, and youll also need your Social Security number to complete your application. In addition, youll need information that helps identify you, such as your birth certificate, drivers license, or proof of U.S. citizenship if you werent born in the U.S. If youre not a citizen, youll need your permanent resident card number.
Documents You Need To Apply For Medicare
To begin the application process, youll need to ensure you have the following documentation to prove identity:
- A copy of your birth certificate
- Your drivers license or state I.D. card
- Proof of U.S. citizenship or proof of legal residency
You may need additional documents as well. Make sure to have on hand:
- Your Social Security card
- W-2 forms if still active in employment
- Military discharge documents if you previously served in the U.S. military before 1968
- Information about current health insurance types and coverage dates
If you are already enrolled in Part A and have chosen to delay enrollment in Part B, you will need to complete additional forms .
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