Recent updates to Social Security policies could create challenges for clients enrolling in Medicare — especially if they’re not aware of how these changes affect their ability to apply. Agents should take extra care to ensure clients start the enrollment process early to avoid any unnecessary delays in their coverage.
Social Security Policy Changes May Affect the Enrollment Process
The Social Security Administration (SSA) had stopped scheduling phone appointments for many benefit claims but then reversed this decision to allow phone appointments again. This is a good thing for beneficiaries who can’t apply online, but the SSA also recently cut 7,000 jobs, which may lead to longer hold times and slower processing of applications. Clients applying late may experience Medicare enrollment delays, so it’s more important than ever to help them get started early.
When Clients CAN Enroll in Medicare Online
Online applications are typically faster and more efficient, and many clients are eligible to apply this way. Below are the main situations where they can do so:
Initial Enrollment Period
If a client is turning 65 and it’s time for them to enroll in Medicare Part A and/or B, they can apply online. This is often the quickest way. If they are already receiving their social security benefits, then they will automatically be enrolled in Part A and Part B. They do not need to actively enroll in this situation.
Special Enrollment Period for Leaving Employer Coverage
Clients who worked past age 65 and are coming off an employer group health plan have an 8-month Special Enrollment Period to apply for Part B. They can also apply online — either for Part A and B or for Part B only if they already have Part A. Applications can be submitted up to three months before the desired effective date. They will need to make sure they upload a completed CMS-L564 Request for Employment Information. Learn how you can help them Choose Between Medicare and Employer Coverage: What Agents Need to Know
General Enrollment Period
If a client missed their Initial Enrollment Period and doesn’t qualify for a Special Enrollment Period, they’ll need to enroll during the General Enrollment Period (January 1 – March 31). In this case, coverage starts the first of the month after they apply. You can apply online during this enrollment period.
When a Client CANNOT Enroll in Medicare Online
There are some situations where clients will not be able to apply online. In these cases, a phone appointment or in-person appointment at the local Social Security office will be required. Encourage clients to schedule as soon as possible to avoid delays. Here are the scenarios when your clients cannot apply online:
Applying for Part A based on a spouse’s work history
Some people do not have enough work credits to qualify for premium-free Part A on their own. If not, they may qualify based on a spouse’s work history. If this is the case, then they will need to have their spouse present when applying. They must complete this enrollment via phone or in-person, not online. They can enroll as early as 3 months before their 65th birthday month.
Applying for Conditional Part A
If they do not qualify for premium-free Part A but are low income, then they could get help from Medicaid to pay their Part A premium. The process requires them to apply for Conditional Part A before applying for Medicaid assistance. Since their Part A enrollment is conditional based on their Medicaid approval, they cannot apply online. They will need to make a phone or in-person appointment with their local Social Security office. Learn more about Conditional Part A in our previous blog, How to Get Help Paying for Premium Part A With Low Income
Applying for Part A and Part B due to exceptional conditions
If they qualify for a Special Enrollment Period based on exceptional conditions, then they will need to complete a different Medicare enrollment form. In this scenario, they cannot apply online, but they can avoid in person appointments if they send their completed form via fax or mail to their closest Social Security office. The Special Enrollment Period to enroll in Part A and Part B is generally 6 months, depending on the exceptional circumstances.
If an in-person appointment or phone is their only option, then encourage them to apply for Medicare as early in the process as possible. If they are new to Medicare, this would be 3 months before their birthday month. This way, they can mitigate any delays and avoid gaps in coverage.
Help Clients Avoid Medicare Enrollment Delays
Social Security delays can easily lead to Medicare delays, so helping clients apply as early as possible — whether online or in person — is key. Agents who stay proactive and informed will be in the best position to guide their clients smoothly through the process.