Medicare Special Enrollment Periods (SEPs)

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Exploring the 3 Ways You May Qualify

Medicare offers Special Enrollment Periods (SEPs) that allow individuals to enroll in or switch Medicare plans outside of the standard enrollment periods. These SEPs are crucial for individuals who experience certain life events or qualify for specific circumstances. Let’s explore what qualifies you for a SEP and how you can take advantage of them.

Qualifying for a Special Enrollment Period

There are three main reasons why you may qualify for a Special Enrollment Period:

  1. Qualifying Life Events (QLEs): If you experience a QLE, such as moving to a new area, losing health coverage, or other life-changing events, you may be eligible for a SEP.
  2. 5-Star Special Enrollment Period: Medicare rates plans on a scale of 1 to 5 stars, with 5 stars being the highest rating. If a 5-star plan becomes available in your area, you can switch to it during a SEP.
  3. Working Past Age 65: If you delayed enrolling in Medicare because you had employer-based coverage, you have an 8-month SEP to enroll in Medicare once that coverage ends.

Qualifying Life Events and Special Enrollment Periods

If you have Medicare and experience a QLE, you may qualify for a SEP to change your Medicare Advantage or Prescription Drug Plan. These events include:

  • Changing your primary residence
  • Losing your health insurance
  • Being eligible for other health insurance

*Each QLE has a specific timeframe within which you must act to qualify for a SEP. For example, if you move, your SEP is typically 60 days after your move.

5-Star Medicare Special Enrollment Period

If a 5-star Medicare plan becomes available in your area, you can switch to it during the 5-star SEP, which runs from December 8 to November 30 of the following year. It’s important to compare plans to ensure the new plan meets your needs.

Enrollment in Medicaid or Extra Help

Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:

  • January – March
  • April – June
  • July – September

If you lose benefits from Medicaid or Extra Help, you will have a one-time opportunity to adjust your Medicare Advantage enrollment.

Disenrollment from your initial Medicare Advantage plan

If you initially enrolled in a Medicare Advantage plan upon becoming eligible for Medicare, you have a 12-month window to disenroll from the plan and return to Original Medicare.

If you previously dropped a Medicare Supplement Insurance plan to join a Medicare Advantage plan but now want to switch back, you also have a 12-month period to do so (as long as this was your first enrollment in a Medicare Advantage plan).

Working Past Age 65 and the Special Enrollment Period for Medicare Part B

If you or your spouse work past the age of 65 and delay enrolling in Medicare, you have an 8-month SEP to enroll in Medicare Part B once you retire or lose employer coverage. This helps you avoid late penalties.

Avoiding Gaps in Coverage and Part D Late Enrollment Penalties

To avoid gaps in coverage, enroll in Medicare before you lose employer-based coverage. If you anticipate retiring, contact your employer’s human resources department one or two months in advance to time your Medicare enrollment correctly.

Understanding Medicare Special Enrollment Periods is crucial for individuals to make informed decisions about their healthcare coverage. Whether you’re experiencing a QLE, have access to a 5-star plan, or are working past age 65, knowing your options and timing is key to maximizing your Medicare benefits.

If you would like more information on the SEP, or to find out if you may qualify, please contact our office today and we would be happy to assist you.

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Empowering Hearts: Celebrating Cardiac Rehab Week & How Medicare Coverage Supports You on Your Road to a Healthier Heart!

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Let’s show our HEART a little more Love!  Cardiac health is a vital aspect of overall well-being, and Cardiac Rehab Week serves as a poignant reminder of the importance of maintaining a healthy heart. This annual celebration not only highlights the significance of cardiac rehabilitation but also emphasizes the important role your Medicare coverage can play at maintaining heart health. Join us as we explore Cardiac Rehab therapy and ‘heart healthy’ benefits under Medicare, and tips on how to show your heart a little extra love through a healthier lifestyle.

Understanding Cardiac Rehab Week

Cardiac Rehab Week, observed annually, aims to raise awareness about cardiac rehabilitation and its positive impact on individuals recovering from heart-related conditions. Did you know that cardiac rehabilitation can reduce the risk of death from heart disease by up to 25%?  It also provides an opportunity to acknowledge the efforts of healthcare professionals, support systems, and patients who contribute to the success of cardiac rehabilitation programs.

Medicare’s Role in Supporting Cardiac Health:

  • Medicare covers cardiac rehabilitation programs for eligible beneficiaries.
  • Cardiovascular Disease Screenings Coverage
  • Cardiovascular Disease Treatment Coverage
  • Cardiovascular behavioral therapy (Medicare Part B)
  • Medical Equipment: Medicare may cover durable medical equipment like blood pressure monitors or cardiac monitors prescribed by your doctor.
  • Medications: Medicare Part D provides coverage for medications prescribed to manage heart conditions, such as high blood pressure or cholesterol.

Your costs in Original Medicare: You pay nothing for the tests if your doctor or other health care provider accepts the assignment.

Costs under Medicare for cardiac rehab vary depending on the location and will include the Part B deductible.  The costs under Medicare often depend upon where you are participating in cardiac rehab. The Part B deductible will apply.

What Diagnosis Qualifies for Cardiac Rehab?

Medicare will cover the costs of cardiac rehabilitation, providing you have a certain medical diagnosis. These include:

  • Having had a heart attack in the past 12 months.
  • History of coronary artery bypass surgery
  • Currently stable angina (chest pain)
  • History of a heart valve repair or replacement
  • History of coronary angioplasty to open a blocked artery or place a stent
  • History of a heart or heart-lung transplant
  • Stable, chronic heart failure

Heart-Healthy Lifestyle Choices for Seniors:

Tips on how to show your HEART a little extra LOVE!

According to a recent 2024 study by the American Heart Association, the average age at first heart attack is 65.6 years for males and 72.0 years for females. This highlights the critical importance of maintaining heart health as we age

By taking advantage of Medicare’s coverage for cardiovascular screenings and wellness visits, along with adopting heart-healthy lifestyle choices, we can empower ourselves to lead healthier, happier lives.

Let’s continue to prioritize our heart health, not just during this special week, but every day of the year. Together, we can make a difference in our cardiovascular health and inspire others to do the same. Here’s to strong hearts and healthier tomorrows!

To learn more about your Medicare benefits, please contact our office today and we would be happy to schedule a plan review with you to ensure you are getting the most out of your benefits! You can also visit our website to schedule an appointment with us.

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