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Do I Qualify for Medicare Special Enrollment?

Qualifying for Medicare coverage outside the traditional Open Enrollment Period involves using a Special Enrollment Period. Certain life events, such as moving, losing your plan, etc. may allow you to join, switch or drop an Illinois Medicare plan.

Special Enrollment Periods – Qualifying Events

Under certain “special” conditions, you may be able to sign up for Medicare coverage outside of regular enrollment periods. Special qualifying events allow seniors in Illinois to enroll in coverage. The following life events may qualify you:

Loss of health care coverage

If you lose your health care coverage, either voluntarily or involuntarily, you may qualify. If you lose coverage provided through work or a family member, expect to in the next 60 days, or have the opportunity to enroll in private coverage offered through an employer, you may qualify. Additionally, if you are no longer eligible for Medicaid, you may qualify for a Special Enrollment Period.

Changes in household size

Certain events like marriage, having a baby, going through a divorce, or death change the household size.

Change in residence

If you move to a new address that isn’t in your current plan’s service area or you have new options available to you in a new area if you are moving in or out of a skilled nursing facility or long-term care facility.

In addition to the above, becoming a U.S. citizen or getting out of jail. Of course, if Medicare terminates your plan’s contract or your contract isn’t renewed.

5-Star Special Enrollment Period

Medicare rates individual plans for quality and performance using a star system from 1 to 5, with 5 considered “excellent”. Using customer satisfaction surveys and information from healthcare providers, updates are made annually giving customers reliable information about any plans they are considering.

You may switch to a 5-star Medicare Advantage plan, Medicare Cost plan, or Medicare Prescription Drug plan during the 5-Star Special Enrollment Period if a 5-star plan is available in your area. However, you may only use this Special Enrollment Period once from December 8 – November 30.

 

 

 

References:

https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html

https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html

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