What is a Medicare SEP?
Those 65 and over, as well as those with specific disabilities and medical conditions, are covered by the federal health insurance program known as Medicare. For many insurance agents, Medicare is an appealing product because it has a built-in audience and allows for a lifetime of earning potential.Â
Navigating Medicare enrollment isn’t always as simple as signing up once and being done. The Annual Enrollment Period (AEP) and Special Enrollment Periods are two of the enrollment periods that Medicare allows for people to enroll in or modify their coverage (SEPs). While many beneficiaries are familiar with AEP, fewer understand the flexibility offered by a Medicare SEP. For both beneficiaries and agents, understanding SEPs is essential to ensuring coverage stays aligned with life’s changes.
This blog post will concentrate on explaining the complexities of Medicare SEPs and how they operate.
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Medicare SEP Explained
An individual who is already enrolled in Medicare may modify their coverage outside of the Annual Enrollment Period (AEP) during a Special Enrollment Period (SEP). The following are some of the most frequently used special election periods:
- The client moved to a new address that is no longer within a plan’s service area (typically a different county)
- Loss of employer or union coverage
- Loss of Medicaid eligibility
- The client becomes eligible for Medicaid (and Medicare)
- Client qualifies for extra help or low-income subsidy
- There is a declared local emergency in the client’s area
These are just a few examples of the types of life events that SEPs are made to accommodate, but there are even more available here. SEPs come in a variety of forms, each with its own set of guidelines and qualifying standards. Depending on the particular type of SEP, different restrictions apply. While some SEPs are triggered by life events, others are accessible to everyone who meets certain requirements.
Special Enrollment Period for Dual Eligible Individuals
If you are eligible for both Medicare and Medicaid, you may be eligible for a Special Enrollment Period. This SEP allows you to enroll in a Medicare Advantage plan or make changes to your existing coverage once per quarter during the first nine months of the year.
Special Enrollment Period for Losing Employer Coverage
If you lose your employer-sponsored health insurance, you may be eligible for a SEP. You have a SEP to enroll in Medicare Part B and/or a Medicare Advantage plan after losing your employer coverage.
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Sell Medicare with Pinnacle
Pinnacle Financial Services is a leading insurance FMO that offers you the best technology in the business while giving you options as well. We are the only FMO in the country that offers both electronic Medicare enrollment platforms: Connecture and Sunfire.Â
When you are contracted with Pinnacle, certified, and ready to sell, both platforms are free of charge for our agents. You will be then able to utilize our tools to check out and then enroll your Medicare beneficiary and provide Medicare quotes to your clients. You will be able to narrow it down to the best Medicare advantage plan for your client with the extra benefits that fit their needs for them. There are no sales quotas or commitments that you need to make to us as we just want to help you grow your business.
Pinnacle has some of the best opportunities to help agents grow as well as receive individualized attention. The Pinnacle Medicare team is always available to assist should you give us a call. If you’re interested in additional information, don’t hesitate in contacting your sales director for more.
Jessica Strauss
Agent Development Director
x7702 | jstrauss@pfsinsurance.com
