top of page
Mother Smiling With Newborn Baby

SPECIAL ENROLLMENT PERIOD (SEP)

Life events change your health insurance needs – Do you qualify for a Special Enrollment Period?

DO I QUALIFY FOR AN ACA SPECIAL ENROLLMENT PERIOD (SEP)?

Life has ups and downs. When a life changing event impacts your health insurance, you may qualify for an Affordable Care Act special enrollment period (SEP). An SEP is a short window outside of open enrollment when you can enroll in an ACA health plan due to a life event. Your new coverage usually starts the first of the month after you enroll.

  • Medicare Part A: Hospital Insurance
    Medicare Part A covers: • Inpatient care in a hospital • Care in a skilled nursing facility • Hospice care • Some home health care Once you turn 65, Medicare Part A is premium-free to most older Americans if you or your spouse worked for at least 10 years and paid Medicare taxes. Medicare is also available for people who get Social Security or Railroad Retirement Board disability insurance, and those with End-Stage Renal Disease (kidney failure) and Lou Gehrig's disease (ALS).
  • Medicare Part B: Medical Insurance
    Medicare Part B helps pay for: • Doctor visits • Outpatient care • Lab services, like X-rays, blood work, and other diagnostic services • Home health services • Certain therapies, like physical and occupational • Durable medical equipment, like wheelchairs, oxygen equipment, and other medical equipment • Mental health service • Many preventive services, like flu shots and cancer screenings. 0 Medicare Part B Costs You must pay a monthly premium for Medicare Part B. The premium could be higher depending on your income. After you meet your Part B deductible, you will pay coinsurance, which is 20% of the Medicare-approved amount for the services you receive. For example, if the Medicare-approved amount for a service is $100,Medicare would pay 580, and you would pay $20. To help you pay for Medicare Parts A&B deductibles and coinsurance, some people choose to purchase a Medigap policy. Medigap There are a lot of different Medigap policies to choose from. They are lettered: A, B. C, D, F, G, K, L. M. and N. Not all plans are available, depending on when you enrolled in Medicare. And Massachusetts, Minnesota, and Wisconsin plans are a bit different. To try to make it easier for you, all plans in each letter group must offer the same basic benefits — theyVe been standardized. The cost may vary, and some may offer more coverage than others. For example, all companies offering Plan A in Tennessee must all cover the same benefits; they can just charge you more or add a few perks. Medigap plans do not cover prescription drugs. Medigap Costs Remember, you do not have to buy a Medigap plan. You can choose to pay the costs that Medicare Parts A&B do not cover out of your own pocket. A Medigap policy just protects you from unexpected costs. Medigap policies vary in price. The price goes up the deeper into the alphabet you go. Plans A and B will cost you less than plan G.
  • Medicare Part C: Medicare Advantage
    Medicare offers more of a one-stop-shop to get your covered benefits called Medicare Advantage Instead of having to sign up for Medicare Parts A&B and choosing to enroll in a Medigap plan, you can get all of the same coverage as Original Medicare. Medicare plans set limits on how much you will have to pay out of pocket each year, like deductibles and coinsurance. This protects you from costs you weren't expecting. Most plans even cover prescription drugs, so you wouldn't need Medicare Part D. There are many Medicare Advantage plans to choose from. Lower cost plans usually require you to get all of your services from in-network healthcare providers. The most common types of plans include: • Health Maintenance Organizations (HMO), which cover the same services as Medicare Parts A&B. • They can offer additional covered services, like dental insurance • You must get your care from your plan's in-network providers or you could have for some or all of those services • Preferred Provider Organizations (PPO), which cover the same services as Medicare Parts A&B • They usually offer a wider network of providers and pay for a greater share of the services you receive from out-of-network providers • More choice usually means you pay higher premium costs each month. There are other types of plans for people meeting certain income or health requirements: • Special Needs Plans (SNP) • These plans are for people with specific diseases, certain health care needs, or limited incomes. • Programs of All-inclusive Care for the Elderly (PACE): • This Medicare and Medicaid program allows people who would need a nursing home-level of care to remain in the community. It is available in most states.
  • Medicare Part D: Prescription Drugs
    Original Medicare — Part A and Part B — does not cover your medicines. If you want help paying prescription drug costs, you will need to get Medicare Part D. You may not need this if your retirement plan covers benefits. Call your retirement plan to find out if you are covered. What you pay will depend on the plan you choose. Most plans have premiums, deductibles, copayments, and coinsurance. Plans change each year. so it is important to check your options.

Qualified Life Changing Events

If you aren't sure if you qualify for a SEP, we can help you figure it out. Please Call: 800-550-8246

DO I QUALIFY FOR MEDICARE SPECIAL ENROLLMENT PERIOD (SEP)?

Because life changes, you can make changes to Medicare Advantage and Medicare Part D (prescription drug) coverage, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

  • Medicare Part A: Hospital Insurance
    Medicare Part A covers: • Inpatient care in a hospital • Care in a skilled nursing facility • Hospice care • Some home health care Once you turn 65, Medicare Part A is premium-free to most older Americans if you or your spouse worked for at least 10 years and paid Medicare taxes. Medicare is also available for people who get Social Security or Railroad Retirement Board disability insurance, and those with End-Stage Renal Disease (kidney failure) and Lou Gehrig's disease (ALS).
  • Medicare Part B: Medical Insurance
    Medicare Part B helps pay for: • Doctor visits • Outpatient care • Lab services, like X-rays, blood work, and other diagnostic services • Home health services • Certain therapies, like physical and occupational • Durable medical equipment, like wheelchairs, oxygen equipment, and other medical equipment • Mental health service • Many preventive services, like flu shots and cancer screenings. 0 Medicare Part B Costs You must pay a monthly premium for Medicare Part B. The premium could be higher depending on your income. After you meet your Part B deductible, you will pay coinsurance, which is 20% of the Medicare-approved amount for the services you receive. For example, if the Medicare-approved amount for a service is $100,Medicare would pay 580, and you would pay $20. To help you pay for Medicare Parts A&B deductibles and coinsurance, some people choose to purchase a Medigap policy. Medigap There are a lot of different Medigap policies to choose from. They are lettered: A, B. C, D, F, G, K, L. M. and N. Not all plans are available, depending on when you enrolled in Medicare. And Massachusetts, Minnesota, and Wisconsin plans are a bit different. To try to make it easier for you, all plans in each letter group must offer the same basic benefits — theyVe been standardized. The cost may vary, and some may offer more coverage than others. For example, all companies offering Plan A in Tennessee must all cover the same benefits; they can just charge you more or add a few perks. Medigap plans do not cover prescription drugs. Medigap Costs Remember, you do not have to buy a Medigap plan. You can choose to pay the costs that Medicare Parts A&B do not cover out of your own pocket. A Medigap policy just protects you from unexpected costs. Medigap policies vary in price. The price goes up the deeper into the alphabet you go. Plans A and B will cost you less than plan G.
  • Medicare Part C: Medicare Advantage
    Medicare offers more of a one-stop-shop to get your covered benefits called Medicare Advantage Instead of having to sign up for Medicare Parts A&B and choosing to enroll in a Medigap plan, you can get all of the same coverage as Original Medicare. Medicare plans set limits on how much you will have to pay out of pocket each year, like deductibles and coinsurance. This protects you from costs you weren't expecting. Most plans even cover prescription drugs, so you wouldn't need Medicare Part D. There are many Medicare Advantage plans to choose from. Lower cost plans usually require you to get all of your services from in-network healthcare providers. The most common types of plans include: • Health Maintenance Organizations (HMO), which cover the same services as Medicare Parts A&B. • They can offer additional covered services, like dental insurance • You must get your care from your plan's in-network providers or you could have for some or all of those services • Preferred Provider Organizations (PPO), which cover the same services as Medicare Parts A&B • They usually offer a wider network of providers and pay for a greater share of the services you receive from out-of-network providers • More choice usually means you pay higher premium costs each month. There are other types of plans for people meeting certain income or health requirements: • Special Needs Plans (SNP) • These plans are for people with specific diseases, certain health care needs, or limited incomes. • Programs of All-inclusive Care for the Elderly (PACE): • This Medicare and Medicaid program allows people who would need a nursing home-level of care to remain in the community. It is available in most states.
  • Medicare Part D: Prescription Drugs
    Original Medicare — Part A and Part B — does not cover your medicines. If you want help paying prescription drug costs, you will need to get Medicare Part D. You may not need this if your retirement plan covers benefits. Call your retirement plan to find out if you are covered. What you pay will depend on the plan you choose. Most plans have premiums, deductibles, copayments, and coinsurance. Plans change each year. so it is important to check your options.

Qualified Life Changing Events

If you aren't sure if you qualify for a SEP, we can help you figure it out. Please Call: 800-550-8246

ROUND BOTTOM (4).png

LET OUR MEDICARE EXPERTS SEE IF YOU QUALIFY FOR A MEDICARE SPECIAL ENROLLMENT PERIOD.

b04f3a03-fc92-410e-b79e-d8a7a7081d65.png
  • Instagram
  • Facebook
  • Twitter
  • LinkedIn

©2022 by Phoenix Alliance Group. All rights are reserved.

Designed By DIGITALAGENXY.COM

bottom of page