Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Highlighting a Medicare Special Enrollment Period (SEP): Enrolling in Medicare After Termination of Medicaid Coverage

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  • Eligibility parameters:
    • When an individual is eligible for Medicare and Medicaid, and Medicaid eligibility is terminated on or after January 1, 2023.
  • Duration:
    • SEP begins when an individual is notified of Medicaid eligibility termination.
    • SEP ends 6 months after termination of Medicaid eligibility.
  • Entitlement to Medicare:
    • Begins the first of the month following the month of Medicare enrollment, on or after January 1, 2023.
    • On or after January 1, 2023, an individual within the SEP timeframe has an option to request Medicare entitlement retroactive to the Medicaid termination date, provided premiums are paid, and other eligibility requirements are met.
    • Effect on previously accrued late enrollment penalties: An individual otherwise eligible for this SEP, but enrolled in Medicare prior to January 1, 2023, is eligible to have collected late enrollment penalties reimbursed and ongoing penalties removed.

Reference: 42 C.F.R. 406.27 (Medicare Part A); 407.27 (Medicare Part B)

May 25, 2023 – K. Holt

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