It is usually best to enroll in Medicare when you are first eligible or after losing insurance based on current work.

Beginning in 2023, If you miss a first-time enrollment period, there are certain times when you might qualify for an exceptional circumstances Special Enrollment Period (SEP). An exceptional circumstance is a situation that is unusual or not typical.

This chart explains different times when you may qualify for a Special Enrollment Period to enroll in Medicare Part B (and premium Part A) without penalty. To use these SEPs submit form CMS-10797 to the Social Security Administration.

You were impacted by an emergency or disaster
You have an SEP if…
Your SEP lasts… To use this SEP…

You missed an enrollment opportunity because you live in an area where the Federal, state, or local government declared an emergency.

You can also use this SEP if the person who makes health care decisions on your behalf lives in an area where there was a declared emergency.

Example: Your Social Security office was closed and you could not enroll in Medicare.

For six months.

Your SEP begins the date the emergency or disaster is declared (as long as it is after January 1, 2023).

Your SEP ends six months after the end date in the emergency declaration. If the emergency declaration is extended, then the six months start with the end date of the extension.

Your coverage begins on the first of the month following the month you enroll.

Contact Social Security.

You must include proof to show that you live or did live in the area when it was affected by the disaster or emergency.

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You got certain types of misinformation from your employer
You have an SEP if…
Your SEP lasts… To use this SEP…

Your employer, employer health insurance plan, or someone acting on behalf of your employer gave you incorrect information that caused you to delay Medicare enrollment. You must have received this misinformation on or after January 1, 2023.

Your decision to not enroll in Medicare must have been a mistake.

Note that not receiving any Medicare enrollment information from your employer does not count as misinformation.

If you received misinformation before January 1, 2023 you cannot use this SEP to enroll in Part B for the first time.

For six months.

Your SEP begins the day you notify Social Security of the misinformation (as long as you received the misinformation on or after January 1, 2023).

Your SEP ends six months after you notify Social Security.

Your coverage begins on the first of the month following the month you enroll.

Contact Social Security.

You must provide documentation that shows you were misinformed by your employer or their representative. An example of proof is a letter from your employer that provides incorrect information about Medicare enrollment. Another example is a letter from your employer that acknowledges that they gave you misinformation.

You can also submit your own written statement describing the misinformation if you do not have written proof from the employer or representative.

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You were released from incarceration
You have an SEP if…
Your SEP lasts… To use this SEP…

You are released from incarceration on or after January 1, 2023.

If you were released from incarceration before January 1, 2023 you cannot use this SEP to enroll in Part B for the first time.

For twelve months.

Your SEP begins the day you are released from incarceration.

Your SEP ends the last day of the twelfth month after you are released.

You have two choices for when coverage will begin:

  • You can choose to have your coverage begin on the first of the following month
  • You can choose to have your coverage begin up to six months retroactively (but coverage cannot begin before January 1, 2023 or before you were released from incarceration)

Contact Social Security.

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Your Medicaid coverage is ending
You have an SEP if…
Your SEP lasts… To use this SEP…

You lose Medicaid eligibility on or after January 1, 2023.

(Note: If you lost Medicaid and enrolled in Medicare before January 1, 2023 and you now have a late enrollment penalty, contact Social Security to get the penalty removed and to be reimbursed for the penalties you already paid.)

For six months.

If your Medicaid eligibility ends on or after January 1, 2023, your SEP begins when you receive notice of upcoming termination of Medicaid eligibility.

Your SEP ends six months after the termination of eligibility.

You have two choices for when coverage will begin:

  • You can choose to have your coverage begin on the first of the month following the month you enroll
  • You can choose to have your coverage begin retroactively back to when your Medicaid ended (but no earlier than January 1, 2023)

Contact Social Security.

You must prove that you are eligible for Medicare and that your Medicaid eligibility ended on or after January 1, 2023.

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You experience other exceptional circumstances
You have an SEP if…
Your SEP lasts… To use this SEP…

Social Security decides that you have experienced an exceptional circumstance.

You can request to enroll through this SEP if you missed other enrollment periods because of situations you could not control. Forgetting to enroll or not knowing that you were supposed to enroll do not count as exceptional circumstances.

Depends on the circumstances.

Contact Social Security.

You may be asked to provide proof of your exceptional circumstance.

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