Special Enrollment Period SEP for Medicare Parts A & B 

When you #lose or give up Group Health Coverage
Watch for the Deadlines!

When you retire, decide you don't want or lose your employer coverage (COBRA doesn't count! ^{CA Health Care Advocates})   you may then have an SEP Special Enrollment Period to enroll in Part B Doctor visits, without penalty.

• Special enrollment period Social Security Publication # 10012
  • You can use an SEP to enroll in Medicare Part B while you’re still in a group health plan based on current employment. Also, if your employment ends or employer-provided medical coverage ends
    • 
  • ssa.gov/medSEP
  • medicare rights.org/Medicare-Part-B-SEP
• If you already have Part A Hospital, you can  enroll online, or  fill out the 
  • #application for Part B  OMB No. 0938-1230 !  and the 
  • Certification from your Employer that you had Group Coverage OMB No. 0938-0787  - L564 E   
    • If the employer can’t fill it out, complete Section B of the form as best you can, but don’t sign it.
      • You’ll need to submit proof of job-based health insurance.
      • What forms of proof can I send?
        • Income tax form that shows health insurance premiums paid
        • W-2s showing pre-tax medical contributions
        • Pay stubs showing health insurance premium deductions
        • Health insurance cards with a policy effective date
        • Explanations of benefits paid by the employer group health plan
        • Statements or receipts that show payment of health insurance premiums
      • You can apply online (at Social Security) - select “Already Enrolled in Medicare” from the menu.
      • Or, fax or mail your forms to your local Social Security office.  ^Medicare.gov *
• This Special Enrollment Period also doesn’t apply if you have one of these:
  • ■ End-Stage Renal Disease (ESRD)
  • ■ Veterans Affairs and
  • Individual Health Insurance Marketplace  - Covered CA  ^{11036-Enrolling-Medicare-Part-A-Part-B.pdf page 13}