To qualify for a Special Enrollment Period, what must an individual have?

To qualify for a Special Enrollment Period, an individual must be covered under a group health plan based on current employment. This provision is designed to ensure that individuals who have active employer-sponsored health insurance do not face penalties or gaps in coverage when transitioning to Medicare.

When individuals are actively working and covered by a job-based health insurance plan, they can delay enrolling in Medicare without incurring late enrollment penalties. If they happen to lose that coverage—due to job loss, reduction in hours, or other qualifying events—they can enroll in Medicare during the Special Enrollment Period without facing penalties or long waits.

In contrast, simply having a valid Medicare card, proof of residency, or prior enrollment in Medicare Part A does not qualify someone for a Special Enrollment Period on its own. These factors may play roles in other aspects of Medicare enrollment, but the key criteria for the Special Enrollment Period is the individual's current employer-based health coverage.