Enroll in Part A and/or B during a Special Enrollment Period

If you are currently enrolled in Medicare Part A only and want to add Part B, you must:

Enroll (after age 65) in Part B

• Visit https://www.ssa.gov/benefits/medicare/#anchor6  “Already Enrolled in Medicare”
• Use Option 1 to complete forms online and upload evidence of your existing (and ending) health insurance: https://www.ssa.gov/Medicare-PartB-SEP  OR use Option 2 to fax or mail the two forms (current versions are attached) and secondary evidence (if needed) to the correct local Social Security office. Find the correct office using this lookup tool: https://secure.ssa.gov/ICON/main.jsp 
• Be sure to state in the remarks when you want Part B to start (Month and Year)
• If the employer cannot complete Section B, submit secondary evidence as listed here: https://www.ssa.gov/benefits/medicare/#anchor6 
• If follow-up is needed, call the Social Security Administration at 1-800-772-1213 from 7am to 7pm, Monday through Friday.

LEAVING EMPLOYER GROUP HEALTH COVERAGE

The most common Special Enrollment Period (SEP) is having coverage through your job or a spouse’s job and having that coverage end or stop work (even if they offer to continue the health insurance for you).

* NOTE: COBRA is NOT Group Health coverage, so don’t take COBRA for 18 months and then try to sign up for Medicare – you will miss this SEP and have to wait until the General Enrollment Period to sign up.

You should sign up for Medicare at the Social Security Administration as soon as possible but no more than 3 months before the intended start date. To avoid the Late Enrollment Penalty, get your employer to provide proof of Creditable Coverage for the period since you turned 65 (or sign the Part B form).

If you have a PDF document (from your employer or your health plan) showing proof of insurance since turning 65, you can apply online here: https://secure.ssa.gov/mpboa/medicare-part-b-online-application/ and upload the document with your application

If you don’t have a PDF document showing proof of insurance since turning 65, download and complete the forms you need:

• If you are not already enrolled in Part A, complete the Application for Enrollment in Medicare Part A (CMS-18F5) (PDF) https://www.cms.gov/files/document/cms-18f5.pdf
• Complete the Application for Enrollment in Medicare Part B (CMS-40B) (PDF). https://www.cms.gov/files/document/cms-40b-application-enrollment-medicare-part-b-medical-insurance.pdf – Be sure to state in the remarks when you want Part B to start (Month and Year)
• Complete the Request for Employment Information (CMS-L564) (PDF) and have the employer complete and sign their section. https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMSL564-E.PDF

You can find your Social Security office https://secure.ssa.gov/ICON/main.jsp and fax or mail them the completed forms directly to that office.

OTHER VALID SPECIAL ENROLLMENT PERIODS

Valid SEP’s also include

• Losing Medicaid (MaineCare)
• Being impacted by a Natural Disaster or Emergency
• Receiving inaccurate or misleading information from your health plan or employer
• Being released from incarceration
• Volunteer and serve in a foreign country
• Have TRICARE
• Experiencing other exceptional conditions.

If you are not sure if you qualify for a Special Enrollment Period, you can view the different types of SEPs here: https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start#SEP

To sign up for Medicare using any of these reasons, download the Application for Medicare Part A and B — Special Enrollment Period (Exceptional Conditions) (CMS-10797) here: https://www.cms.gov/files/document/application-medicare-part-part-b-special-enrollment-period-exceptional-conditions.pdf and submit to your local Social Security office. Find your Social Security office https://secure.ssa.gov/ICON/main.jsp and fax or mail them the completed form.

NO VALID SEP?

Some situations don’t qualify for a Special Enrollment Period:

• Your COBRA coverage or retiree coverage ends.
• You missed your 8-month sign-up window when you stopped working or lost job-based coverage.
• You have or lose your Marketplace (ACA) coverage.
• You have End-Stage Renal Disease (ESRD). Learn more about Medicare coverage for ESRD here: https://www.medicare.gov/basics/end-stage-renal-disease

If you don’t have a valid SEP, you must wait until the General Enrollment Period (Jan 1 to Mar 31) and you will pay an extra 10% (for the rest of your life) for EACH year you could have signed up for Part B but didn’t. Call Social Security at 1-800-772-1213 to discuss your options as soon as possible.