What happens if an individual is covered by a group health plan and loses that coverage?

When an individual is covered by a group health plan and subsequently loses that coverage, they may qualify for a Special Enrollment Period (SEP) to enroll in Medicare. This is critical because the Special Enrollment Period allows individuals to sign up for Medicare without facing penalties or delays that usually accompany enrollment outside the standard enrollment periods.

The Special Enrollment Period is designed to provide flexibility and support for those who may experience changes in their health insurance status, such as losing employer-sponsored coverage. This typically applies to individuals who are 65 or older or who have disabilities and are eligible for Medicare. It is important for them to act promptly during this period to ensure they receive the necessary benefits without incurring gaps in coverage.

If individuals were unable to use the special enrollment option, they might have to wait for the next general enrollment period, which could lead to a delay in coverage, potential penalties, or increased costs—situations the SEP aims to prevent.