Problem:

Mr. N is 50 years old and had Medicare Part A due to a disability. He declined to take Part B because he had his primary insurance through his domestic partner, who worked at a company with more than 100 employees. Recently, his domestic partner found a new job. When Mr. N tried to enroll in Medicare Part B, during his Part B Special Enrollment Period (SEP) Social Security told him he was not eligible for a Special Enrollment Period because his insurance came through a partner, not a spouse. He was also told that he would have to wait to enroll until the next General Enrollment Period (GEP), which goes from January through March of every year with coverage beginning in July.

What To Do:

Mr. N called his local State Health Insurance Assistance Program (SHIP) for help. A SHIP counselor found the Social Security policy, which states that if a company provides group health insurance benefits to domestic partners, a person under the age of 65 is considered a family member for the purposes of Medicare enrollment. Family members of people with disabilities qualify for an SEP if their coverage comes from a large employer (100 people or more). If Mr. N was over 65, he would not have been eligible for the SEP. Mr. N was found eligible for a SEP outside of the General Enrollment Periods for Medicare Part B.

For more information on when to enroll into Medicare Part B, please click here.

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