Medicare Part B Special Enrollment Period

Based on having Employer Coverage – Current Employement

A Medicare Part B Special Enrollment Period may let you sign up for Medicare Part B without a late enrollment penalty if you delayed Part B because you or your spouse had employer group health coverage based on current employment.

• • Email Steve
  • Set a Zoom Meeting

When does a Part B SEP apply?

In general, the Part B SEP applies when you had group health plan coverage through your own or your spouse’s current employment. You may enroll while that employer group coverage is still active, or during the 8-month period that begins after the employment or group health coverage ends, whichever happens first. Social Security explains the 8-month SEP here.

Important: COBRA / Cal-COBRA does not extend the 8-month Part B SEP. Medicare.gov says the 8-month Part B SEP starts when you stop working, even if you choose COBRA or other non-Medicare coverage. Medicare.gov — When can I sign up for Medicare?

What forms are usually needed?

• CMS-40B — Application for Enrollment in Medicare Part B.
• CMS-L564 — Request for Employment Information, usually completed by the employer to prove group coverage based on current employment.
• Social Security online SEP application – Use your Social Security Account  – Create one  — If you already have Medicare Part A, Social Security may let you submit the Part B SEP request online.
• cms.gov/application-medicare-part-part-b-special-enrollment-period-exceptional-conditions
  • natural emergency or disaster,
  • losing Medicaid coverage, or
  • being released from jail.
  • Learn more  Medicare.Gov

What if the employer will not complete form CMS-L564?

If the employer cannot or will not complete the form, Social Security may ask for other proof of job-based coverage, such as tax records showing premiums paid, W-2s showing pre-tax medical contributions, pay stubs showing health insurance deductions, insurance cards with effective dates, explanations of benefits, or premium statements.

This SEP usually does not apply to these situations

• COBRA / Cal-COBRA by itself after employment ends.
• Retiree coverage not based on current employment.
• Covered California or other individual Marketplace coverage.
• VA coverage.
• End-Stage Renal Disease — ESRD, which has special Medicare rules.

What should you do next?

1. Confirm whether your prior coverage was based on current employment.
2. Confirm the date employment ended and the date group health coverage ended.
3. Ask the employer to complete CMS-L564.
4. Complete CMS-40B and clearly state the month you want Part B to begin.
5. Submit the forms to Social Security online, by fax, by mail, or through your local Social Security office.

FAQs

• Can I use the Part B SEP if I have COBRA?
  • Usually, no. COBRA / Cal-COBRA may be useful in some situations, but COBRA is not the same as active employer group coverage based on current employment. Do not assume COBRA protects you from a Part B late enrollment penalty.
• How long do I have after employment or group coverage ends?
  • The standard Part B SEP is generally 8 months after employment ends or the employer group health coverage ends, whichever happens first. Social Security explains the timing here.
• Can I pick the month Part B starts?
  • You should write the month and year you want Part B to begin in the remarks section of CMS-40B. Social Security makes the final determination.
• What if I missed the SEP?
  • You may need to use the Medicare General Enrollment Period, and a late enrollment penalty may apply. There may also be limited exceptional-condition SEP rules, depending on the facts.

Official references

• Social Security: Special Enrollment Period for Medicare Part B
• Medicare.gov: When can I sign up for Medicare?
• Medicare.gov: When does Medicare coverage start?
• Special enrollment period Social Security Publication # 10012  how to apply
• ssa.gov/medSEP
• medicare rights.org/Medicare-Part-B-SEP
• #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
• 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}