Understanding Medicare Special Enrollment Periods

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Medicare enrollment typically follows specific timeframes, such as when you first become eligible around age 65 or during the annual fall enrollment period. However, life changes don’t always align with these standard schedules.

Medicare provides flexibility through Special Enrollment Periods (SEPs). These periods allow you to enroll in Medicare or adjust existing coverage outside the usual times due to qualifying life events.

This guide explains what SEPs are, which circumstances trigger them, the specific rules that apply, and how you can use these opportunities to maintain continuous health coverage.

What is a Medicare Special Enrollment Period?

A Medicare Special Enrollment Period is a designated time outside standard Medicare enrollment periods when eligible individuals can enroll in or make changes to their Medicare coverage.

These opportunities are triggered by specific life events, often called Qualifying Life Events (QLEs).

SEPs provide a safety net, allowing individuals experiencing specific life changes—such as losing other health coverage, moving, or changes in eligibility for assistance programs—to access or modify Medicare coverage without delay. This helps prevent gaps in healthcare access and allows you to avoid potential late enrollment penalties.

The rules governing SEPs, including the duration of the enrollment window and the types of coverage changes permitted, vary depending on the specific QLE.

SEPs function differently depending on whether they pertain to:

• Original Medicare (Parts A and B): Often related to changes in work status and employer health coverage; typically managed through the Social Security Administration
• Private Medicare plans (Part C and D): Cover a broader range of life events; handled through Medicare directly or private insurance companies

Common Life Events Triggering an SEP

Losing Employer or Union Health Coverage

One of the most frequent triggers for an SEP is the loss of group health plan (GHP) coverage based on current employment, either for you or your spouse.

Timing for Part B: For enrolling in Medicare Part B, this SEP generally lasts for 8 months. It begins the month after your current employment ends or after your GHP coverage based on that employment ends, whichever occurs first.

You can enroll at any point while still covered by the GHP based on current employment or during this 8-month window after employment or coverage ends. Coverage typically begins the month after your enrollment application is processed.

If the loss of coverage occurs during your Initial Enrollment Period (IEP), this specific 8-month SEP does not apply; the IEP rules take precedence.

Timing for Part C/D: Losing employer or union coverage also triggers an SEP to join a Medicare Advantage (Part C) plan or a Medicare Prescription Drug (Part D) plan. This SEP window is shorter, lasting for 2 full months after the month your coverage ends.

Enrollment in Parts A and/or B is a prerequisite for joining a Part C or Part D plan.

Required Documentation: Documentation confirming your GHP coverage and its end date is usually required. The Request for Employment Information form (CMS-L564) is often used when applying through the Social Security Administration.

COBRA and Retiree Plans: COBRA continuation coverage and retiree health plans are not considered to be based on current employment. The 8-month SEP for Part B begins when your active employment ends, not when subsequent COBRA or retiree coverage ends.

Electing COBRA does not extend the 8-month Part B enrollment window. If you’re relying on COBRA or retiree coverage, be mindful of the timeline based on the end of active work to avoid potential Part B late enrollment penalties.

Different Timelines: Note the difference between the 8-month Part B SEP and the shorter 2-month Part C/D SEP following loss of employer coverage. To ensure seamless enrollment into a desired Part C or Part D plan immediately following the loss of employer coverage, aim to enroll in Part B and select your Part C or D plan within the first 60 days after your employer coverage ends.

Moving Your Residence

Changes in residence can trigger an SEP for Medicare Advantage and Part D plans under several circumstances:

• Moving outside your current plan’s service area
• Moving to a new location within your current plan’s service area but gaining access to different plan options
• Moving back to the United States after living outside the country
• Moving into or out of an institution, such as a skilled nursing facility or long-term care hospital

Temporary moves, such as for a vacation or medical treatment, generally do not qualify for this SEP.

Timing for Part C/D: The timing for this SEP typically allows enrollment or plan changes for 2 full months following the month of your move.

You can gain extra time by notifying your plan before moving. If you inform your plan in advance, the SEP begins the month before the move and continues for 2 full months after, providing a longer window to manage the transition.

For those returning to the U.S., the SEP lasts for 2 full months after the month you move back. For institutional moves, the SEP is available continuously while residing in the institution and for 2 full months after the month of moving out.

Eligible Parts: This SEP primarily facilitates changes to Medicare Advantage (Part C) and Prescription Drug (Part D) plans. If you move out of your MA plan’s service area and do not enroll in a new plan during the SEP, you’ll typically be disenrolled from the MA plan and returned to Original Medicare.

Required Documentation: Proof of your new address, such as a driver’s license, utility bill, or lease agreement, may be required by the new plan.

Changes in Medicaid or Extra Help Eligibility

Eligibility for Medicaid or the Extra Help program (also known as the Low-Income Subsidy or LIS, which assists with Part D costs) significantly impacts SEP opportunities.

Triggers: Gaining or losing eligibility for Medicaid, or gaining or losing eligibility for Extra Help (LIS).

Timing for Part C/D: Individuals eligible for both Medicare and Medicaid (“dual eligibles”) and those receiving Extra Help traditionally have an ongoing SEP that allows them to change their Medicare Advantage or Part D plan once per calendar quarter. Changes made typically become effective on the first day of the following month.

A significant policy change is scheduled for January 1, 2025. Starting then, dual eligibles and LIS recipients will have the opportunity to make certain plan changes monthly, rather than quarterly. These monthly changes will include:

• Switching between Original Medicare (with a standalone Part D plan) and a Medicare Advantage plan (particularly integrated plans like D-SNPs or Medi-Medi plans)
• Switching between standalone Part D plans if enrolled in Original Medicare

The existing quarterly SEP for these individuals will be discontinued.

Even with the new monthly flexibility, enrolling in or switching between regular (non-integrated) Medicare Advantage plans may still be restricted outside of standard enrollment periods unless another specific SEP applies.

If you lose Medicaid or Extra Help eligibility, a different SEP is triggered. For Part C/D changes, this SEP generally lasts for 3 full months beginning either the month you are notified of the loss or the month the eligibility ends, whichever is later.

Timing for Part A/B (Loss of Medicaid): A specific SEP exists for enrolling in Medicare Part A and/or Part B if Medicaid coverage is lost on or after January 1, 2023. This SEP begins when you are notified of the impending loss of Medicaid and ends 6 months after the Medicaid coverage actually ends.

Eligible Parts: These SEPs allow joining, switching, or dropping MA (Part C) and Part D plans. The specific SEP following Medicaid loss also allows enrollment in Part A/B.

Required Documentation: Documentation confirming Medicaid or LIS eligibility status (or loss thereof) from the state Medicaid agency or the Social Security Administration.

Changes Related to Your Current Medicare Plan

Actions taken by your current Medicare Advantage or Part D plan can also trigger an SEP.

Triggers:

• The plan changes its service area
• The plan terminates its contract with Medicare
• The plan otherwise stops offering coverage
• An SEP is also available related to high-performing plans

Timing for Part C/D: If a plan terminates its contract or reduces its service area effective December 31, beneficiaries typically receive an SEP allowing them to switch plans. This SEP often starts before the termination (e.g., beginning December 8) and extends into the new year (e.g., through the end of February).

Plans are required to notify members of significant changes via the Annual Notice of Change (ANOC), usually sent before September 30 each year.

Additionally, Medicare provides a 5-Star Special Enrollment Period: individuals can switch one time per year (between December 8 and November 30 of the following year) into an MA plan, Part D plan, or Cost plan that has an overall quality rating of 5 stars from Medicare.

Eligible Parts: Allows switching between MA (Part C) plans or Part D plans. If an MA plan terminates its contract or leaves a service area, beneficiaries can switch to another MA plan or return to Original Medicare, potentially adding a standalone Part D plan.

Required Documentation: Official notices from the Medicare plan (e.g., ANOC, termination letter). Plan ratings can be verified using the Medicare Plan Finder tool.

Changes in Household (Limited Scope for Medicare SEPs)

Common life events like marriage or divorce have a more limited impact on Medicare SEPs compared to rules for other types of health insurance, such as plans offered through the Affordable Care Act (ACA) Marketplace.

Triggers: For Medicare purposes, events like getting married, divorced, having a baby, or adopting a child generally do not trigger an SEP unless the event directly causes a loss of qualifying health coverage.

For example, if a divorce results in the loss of coverage under a spouse’s employer GHP, the standard SEP for loss of employer coverage would apply. Similarly, the death of a spouse providing coverage could trigger a loss-of-coverage SEP.

Timing/Parts: If a qualifying loss of coverage occurs due to a household change, the timing and eligible parts follow the rules for that specific loss-of-coverage SEP (e.g., the 8-month Part B SEP or the 2-month Part C/D SEP after losing employer GHP).

Contrast with ACA: It’s important to understand this difference if you’re familiar with ACA Marketplace rules. The Marketplace provides broad SEPs for marriage, birth, adoption, and divorce even without loss of coverage. Medicare does not automatically grant SEPs for these events; the trigger is typically tied to the resulting loss of other creditable health insurance.

Common Medicare SEPs at a Glance

*Note: For Dual Eligibles/LIS recipients, the SEP frequency for certain C/D changes transitions from quarterly to monthly starting January 1, 2025.

Less Common Situations Granting SEPs

Beyond the more frequent triggers, Medicare recognizes several other specific circumstances that can grant an SEP.

Release from Incarceration

Individuals released from incarceration may qualify for an SEP to enroll in Medicare or join a plan.

Trigger: Release from jail or other penal institution.

Timing & Eligible Parts: There are two potential SEPs depending on the situation:

1. Part C/D Enrollment: If you maintained Medicare Part A and/or Part B coverage while incarcerated, you have an SEP lasting 2 full calendar months after the month of release to join a Medicare Advantage (Part C) or Part D plan. Enrollment in Part A and/or B is a prerequisite.
2. Part A/B Enrollment (Exceptional Conditions): A newer SEP, effective January 1, 2023, applies if you were released within the last 12 months and either your Medicare coverage was terminated due to non-payment of premiums while incarcerated, or you were eligible for Medicare but couldn’t enroll due to your incarceration. This SEP allows enrollment in Part A and/or Part B and lasts for 12 months starting the day of release. Under this SEP, coverage can potentially begin retroactively up to 6 months prior to enrollment (but no earlier than the month of release), though premiums for the retroactive period would be due.

Required Documentation: Documentation verifying the date of release from incarceration. For the 12-month Part A/B SEP, Form CMS-10797 (“Application for Medicare Part A & Part B – Special Enrollment Period (Exceptional conditions)”) may be required.

Losing Coverage from a PACE Plan

The Program of All-inclusive Care for the Elderly (PACE) offers a comprehensive package of medical, social, long-term care, and prescription drug services to frail older adults who meet nursing home level of care criteria but can live in the community. Leaving a PACE plan triggers an SEP.

Trigger: Voluntarily disenrolling from or being disenrolled by a PACE plan.

Timing for Part C/D: This event grants an SEP to join a different Medicare Advantage plan or a standalone Part D plan. While specific timing might vary, it generally aligns with other loss-of-coverage SEPs, typically providing 2 months after the PACE coverage ends to make a new selection.

Individuals meeting PACE criteria can enroll in a PACE plan during any month of the year.

Eligible Parts: Allows joining a Medicare Advantage (Part C) or Part D plan.

Required Documentation: Confirmation of disenrollment provided by the PACE organization.

Enrollment/Disenrollment Errors

Mistakes made by Medicare, Social Security, health plans, or even employers can sometimes lead to improper enrollment or prevent timely enrollment.

Trigger: Errors made by federal employees, plan agents/brokers, or health plan representatives that result in an individual being enrolled in the wrong plan, not enrolled when they should have been, or incorrectly disenrolled.

A specific SEP (effective January 1, 2023) also exists if you did not enroll in Part B during a valid enrollment period due to misinformation provided by your employer, GHP, or an agent/broker acting on behalf of a health plan.

Timing: The duration and timing vary based on the specific error. For the SEP related to employer/GHP misrepresentation regarding Part B enrollment, the SEP begins the day you notify the Social Security Administration (SSA) of the misrepresentation and lasts for 6 months.

For other types of errors, the SEP often starts once the error is identified, and its duration is determined based on the circumstances.

Eligible Parts: Depending on the nature of the error, this SEP can allow for retroactive enrollment or disenrollment, correction of plan choice, or provide a new window to enroll in Parts A, B, C, or D.

Required Documentation: Documentation supporting the claim of error is crucial. This might include correspondence, plan records, or a written attestation detailing the misrepresentation (required for the employer misrepresentation SEP). Resolving these situations typically requires contacting SSA or Medicare directly.

Medicare Advantage (MA) Trial Period

Medicare provides opportunities for individuals new to Medicare Advantage plans to try them out and return to Original Medicare if desired.

Trigger: This applies in specific situations, primarily:

1. You enroll in an MA plan when first eligible for Medicare (during your IEP).
2. You drop a Medigap (Medicare Supplement Insurance) policy to enroll in an MA plan for the first time.

These scenarios grant a “trial right.”

Timing & Eligible Parts: The traditional “trial right” generally allows you to disenroll from the MA plan and return to Original Medicare (Parts A & B) within the first 12 months of joining.

If you dropped a Medigap policy to join the MA plan, you may have guaranteed rights to rejoin your previous Medigap policy or buy a new one (subject to availability and state rules).

Additionally, separate from the 12-month trial right, if you join an MA plan during your Initial Enrollment Period, you have the first 3 months after your Parts A & B coverage starts to switch to a different MA plan or return to Original Medicare (and potentially join a Part D plan).

This 3-month window overlaps somewhat with the annual Medicare Advantage Open Enrollment Period (MA OEP), which runs Jan 1 – Mar 31 for anyone enrolled in an MA plan.

Required Documentation: Enrollment records demonstrating that you meet the criteria for the trial period (e.g., first enrollment in MA during IEP, or first enrollment after dropping Medigap).

Impact by Natural Disaster or Emergency

Major weather events or other declared emergencies can disrupt your ability to manage Medicare enrollment.

Trigger: Residing in an area formally declared a disaster or public health emergency by a federal, state, or local government entity. For the Part A/B SEP under exceptional conditions, the declaration must be on or after January 1, 2023.

Timing: The Centers for Medicare & Medicaid Services (CMS) typically announces the availability and duration of an SEP following major disasters. For the exceptional conditions SEP allowing Part A/B enrollment, it begins retroactively to the start date of the incident period defined in the declaration and ends 6 months after the declaration’s end date (including any extensions).

SEPs for Part C/D changes related to disasters are also typically time-limited, often extending for a few months past the end of the incident period.

Eligible Parts: Depending on the scope defined by CMS, the SEP can allow enrollment or changes related to Parts A, B, C, and D.

Required Documentation: Verification of residence within the officially declared disaster area during the specified timeframe. Form CMS-10797 is used for the Part A/B exceptional conditions SEP. Information is usually available on Medicare.gov or by calling 1-800-MEDICARE.

Other Exceptional Conditions

Medicare provides a pathway for individuals who missed an enrollment period due to unforeseen and uncontrollable circumstances not covered by other SEPs.

Trigger: Experiencing circumstances beyond your control that occurred on or after January 1, 2023, and directly caused the failure to enroll in Part A or B during the IEP, GEP, or another applicable SEP. Eligibility is determined by SSA on a case-by-case basis.

Timing for Part A/B: The SEP begins once you contact SSA about the situation and lasts for at least 6 months. Coverage generally starts the month after enrollment.

Eligible Parts: Primarily facilitates enrollment in Part A and Part B.

Required Documentation: Requires submitting Form CMS-10797 along with a written statement (“attestation”) detailing the exceptional circumstances that prevented timely enrollment.

How to Use Your Special Enrollment Period

Utilizing an SEP involves several key steps, and the process differs depending on whether enrollment is for Original Medicare (Parts A/B) or for Medicare Advantage/Part D plans (Parts C/D).

Confirm Eligibility & Timing

The first step is to verify that your life event qualifies for an SEP and to understand the specific deadline for taking action.

Official resources like the Medicare website provide detailed information on various SEPs. Calling 1-800-MEDICARE (1-800-633-4227) is another way to get clarification.

Gather Necessary Documentation

Collect any required documentation to verify the QLE. This could include:

• Letters confirming loss of coverage
• Proof of a new address
• Release documentation from incarceration
• Medicaid notices
• Specific CMS forms

Having this documentation ready will streamline the application process.

Apply or Make Changes

The application process depends on the type of Medicare coverage involved:

For Parts A & B: Enrollment during an SEP is handled by the Social Security Administration (SSA). Applications can often be submitted online via the SSA website.

Alternatively, you can call SSA or submit paper applications by fax or mail to your local Social Security office. Specific forms may be required depending on the SEP:

• CMS-40B (Application for Enrollment in Medicare Part B): Used when enrolling in Part B after initially declining or delaying it
• CMS-L564 (Request for Employment Information): Used alongside CMS-40B to provide proof of GHP coverage based on current employment when using the SEP related to loss of that coverage
• CMS-10797 (Application for Medicare Part A & Part B – Special Enrollment Period (Exceptional conditions)): Used for SEPs related to emergencies, incarceration, Medicaid loss, employer misrepresentation, or other exceptional conditions

For Parts C (Medicare Advantage) & D (Prescription Drug Plans): Changes or enrollment during an SEP are typically handled directly with the private insurance companies offering the plans or through Medicare resources. Options include:

• Using the Medicare Plan Finder tool on the official Medicare website to compare plans and enroll online
• Contacting the desired plan directly via their website or phone number to enroll
• Calling 1-800-MEDICARE for assistance with comparing plans and enrolling

When switching between Part C or Part D plans, enrolling in the new plan typically automatically triggers disenrollment from the old plan; separate cancellation is usually not needed.

Coverage Start Date

The date coverage begins varies:

• For Part B enrollment using the GHP SEP, coverage often starts the first day of the month after SSA receives the application
• For Part A/B enrollment under an exceptional conditions SEP, coverage usually starts the month after enrollment, unless a retroactive start date is requested and approved (requiring back-payment of premiums)
• For Part C and D plans joined during an SEP, coverage typically begins on the first day of the month after the plan receives the enrollment request

SEPs vs. Other Medicare Enrollment Periods

Special Enrollment Periods are distinct from the standard, scheduled enrollment periods available to Medicare beneficiaries.

Initial Enrollment Period (IEP)

Trigger: Based on initial eligibility for Medicare, typically turning 65 or, for individuals under 65, reaching the 25th month of receiving Social Security or Railroad Retirement Board disability benefits.

Timing: A 7-month window beginning 3 months before the month of eligibility (65th birthday or 25th month of disability), including the month of eligibility, and ending 3 months after.

Action: The primary opportunity to enroll in Medicare Part A and Part B, generally without late enrollment penalties. Individuals can also enroll in a Medicare Advantage (Part C) plan or a Part D prescription drug plan during their IEP.

Key Difference from SEP: Tied to initial eligibility, occurs only once, and has a fixed 7-month duration. SEPs are triggered by specific life events occurring after initial eligibility and have varying durations based on the event.

General Enrollment Period (GEP)

Trigger: Available for individuals who did not enroll in Medicare Part B (or premium Part A) during their IEP and do not qualify for an SEP.

Timing: Occurs annually from January 1 through March 31.

Action: Allows enrollment in Part B (and premium Part A). Coverage begins the first day of the month after enrollment. Enrolling during the GEP usually results in late enrollment penalties for Part B (and potentially Part A if premium is required).

Key Difference from SEP: A fixed annual window for those who missed prior opportunities; penalties are common. SEPs are event-driven, occur throughout the year, and often allow penalty-free enrollment if specific conditions are met.

Annual Enrollment Period (AEP) / Fall Open Enrollment

Trigger: An annual opportunity for individuals already enrolled in Medicare to review and change their coverage choices for the upcoming year.

Timing: Takes place each year from October 15 through December 7.

Action: Allows beneficiaries to:

• Join, switch, or drop a Medicare Advantage (Part C) plan (with or without drug coverage)
• Join, switch, or drop a Medicare Part D prescription drug plan
• Switch between Original Medicare and a Medicare Advantage plan

Changes made during AEP take effect on January 1 of the following year. AEP cannot be used for initial enrollment in Part A or Part B.

Key Difference from SEP: A predictable, annual period focused on plan changes for existing beneficiaries, not initial enrollment or event-driven changes outside this timeframe. SEPs allow changes at other times due to specific circumstances.

Medicare Advantage Open Enrollment Period (MA OEP)

Trigger: Available only to individuals currently enrolled in a Medicare Advantage (Part C) plan.

Timing: Occurs annually from January 1 through March 31. It also applies during the first 3 months an individual has Medicare Parts A & B if they enrolled in an MA plan during their IEP.

Action: Allows individuals enrolled in an MA plan to make one change during the period:

• Switch to a different MA plan (with or without drug coverage), or
• Drop their MA plan and return to Original Medicare

If returning to Original Medicare, they can also join a standalone Part D plan. Individuals cannot use the MA OEP to switch from Original Medicare to an MA plan. Changes take effect the first of the month after the plan receives the request.

Key Difference from SEP: Restricted to existing MA enrollees, occurs during a fixed annual window (plus the initial 3-month window for some), permits only one change, and has limited action options compared to the flexibility offered by various SEPs triggered by specific life events.

Medicare Enrollment Periods Compared

Frequently Asked Questions

What happens if an SEP deadline is missed?

Missing an SEP deadline generally means waiting for the next available standard enrollment period – such as the General Enrollment Period (GEP) for Part B or the Annual Enrollment Period (AEP) for Part C/D changes.

Missing the Initial Enrollment Period (IEP) or a qualifying SEP for Part B (or premium Part A) without having other qualifying coverage can lead to lifelong late enrollment penalties added to the monthly premium.

The Part B penalty is typically 10% of the standard premium for each full 12-month period enrollment was delayed.

Similarly, delaying Part D enrollment without having other creditable drug coverage for 63 consecutive days or more after the IEP can result in a Part D late enrollment penalty, calculated as 1% of the national base beneficiary premium for each month of delay, also typically paid for life.

The Part A penalty, for those who must pay a premium, is a 10% premium increase paid for twice the number of years enrollment was delayed.

Can retroactive coverage be obtained with an SEP?

Generally, coverage obtained through an SEP starts prospectively, often the first day of the month after enrollment is completed.

However, certain newer SEPs established under “Exceptional Conditions” (effective January 1, 2023) do offer an option for retroactive coverage. For instance, the SEP for release from incarceration and the SEP following termination of Medicaid eligibility allow individuals to choose coverage effective back to the month of release or the month Medicaid was lost, respectively (up to 6 months retroactive for incarceration).

Choosing retroactive coverage requires paying premiums for all months covered retroactively.

Separately, premium-free Part A coverage can begin up to 6 months retroactively from the date of application, but no earlier than the first month of eligibility.

How does having COBRA affect the Part B SEP after employment ends?

COBRA coverage does not extend the 8-month Special Enrollment Period for Part B that begins after current employment ends.

COBRA is not considered coverage based on current employment. The 8-month clock for enrolling in Part B starts ticking the month after active employment or the employer GHP coverage ends, whichever is first, regardless of COBRA election.

Do not wait until your COBRA coverage expires if the 8-month Part B SEP window has already started or passed, as doing so could result in late enrollment penalties and a gap in medical coverage.

What is “creditable coverage” and why is it important for Part D?

Creditable prescription drug coverage refers to other drug coverage (e.g., from an employer, union, TRICARE, VA) that is expected to pay, on average, at least as much as Medicare’s standard Part D prescription drug coverage.

Losing creditable drug coverage triggers an SEP, usually lasting 2 full months, to enroll in a Medicare Part D plan.

Maintaining creditable coverage is also crucial because it allows you to delay enrolling in Medicare Part D beyond your Initial Enrollment Period without facing the Part D late enrollment penalty, provided you enroll promptly (avoiding a gap of 63 consecutive days or more) once that creditable coverage ends.

Health plans providing drug coverage are required to notify their members annually whether the coverage is considered creditable.

Having other creditable drug coverage also grants an ongoing SEP to drop Medicare Part D coverage at any time.

How do SEPs work for individuals with Medicaid or Extra Help (LIS)?

Individuals eligible for both Medicare and Medicaid (dual eligibles) or those receiving the Low-Income Subsidy (LIS, or Extra Help) have enhanced flexibility through SEPs.

Currently, they often have a quarterly SEP to change their Medicare Advantage or Part D plans. Starting in 2025, this is shifting to allow certain changes (like switching between MA and Original Medicare + PDP, or changing PDPs) on a monthly basis.

This frequent access to SEPs allows these beneficiaries to adjust their coverage more readily if their needs change.

Losing Medicaid or LIS eligibility also triggers specific SEPs to allow for transition to other coverage.

Can an SEP be used to enroll in Part B if an individual already has Part A?

Yes. Many individuals enroll in premium-free Part A when they turn 65 but delay Part B if they have coverage through current employment.

If they later lose that employer coverage, they can use the corresponding 8-month SEP to enroll in Part B without penalty.

Other SEPs, such as those related to exceptional conditions, may also allow Part B enrollment if the criteria are met.

If no SEP applies, the General Enrollment Period (GEP) is an option, but late enrollment penalties are likely.

What if an employer provided incorrect advice about enrolling in Part B?

Recognizing that individuals may rely on employer guidance, Medicare established a specific SEP (effective January 1, 2023) for situations where misinformation from an employer, GHP, or plan agent/broker caused an individual to miss enrolling in Part B during a valid period (like the IEP or the GHP-related SEP).

This SEP starts when you notify the Social Security Administration (SSA) of the situation and lasts for 6 months.

You’ll need to provide a written statement (attestation) about the misinformation received and typically use Form CMS-10797 when applying through SSA.

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