Often, the primary source of information about Medicare for working individuals is their employer or the carrier of their GHP. Despite the Centers for Medicare & Medicaid Services' (CMS) efforts to provide information to the working population, the potential for the dissemination of misinformation exists. In some cases, individuals may receive erroneous information from their employer or GHP that results in the individual not engaging in timely Part B enrollment and consequently being assessed a premium surcharge.

1. 1. 

   This SEP applies for individuals whose non-enrollment in premium Part A or Part B is unintentional, inadvertent, or erroneous and results from material misrepresentation or reliance on incorrect information provided by an employer or GHP, brokers or agents of private health plans, or anyone authorized to act on behalf of such organization. Note that the agents or brokers of private health plans are not required to be direct employees of the health plan in order to qualify as sources of misinformation for the purposes of this SEP.

2. 2. 

   To be eligible for this SEP, an individual must demonstrate that they:

1. a. 

   Did not enroll in premium Part A or Part B during their IEP, GEP or another SEP in which they were eligible based on information received from an employer, GHP, or brokers or agents of private health plans that may have been a source of misinformation, and

2. b. 

   An employer, GHP, or brokers or agents of a private health plan materially misrepresented information or provided incorrect information relating to enrollment in premium Part A or Part B. The material misrepresentation or incorrect information must have occurred on or after January 1, 2023.

1. 1. 

   Primary Proof

   The individual will be required to provide documentation of the relevant misrepresentation to SSA. The documentation must show the:

   • •

     information was provided directly from an employer, GHP, or agent or brokers of a private health plan prior to their IEP, GEP or another SEP, and

   • •

     inaccuracy that caused the individual not to enroll timely.

   Example: The individual receives a letter (or GHP website public notice) from their employer or GHP that materially misrepresents the Medicare enrollment process which caused them to not enroll in Medicare during their IEP.

   NOTE: Form CMS-L564 (Request for Employment Information) is not required for this SEP enrollment.

2. 2. 

   Secondary Proof

   Alternatively, a written and signed statement from the beneficiary is sufficient evidence for eligibility for this SEP.

   The written statement must include a detailed account of the incident including:

• •

  the name and title of the person who provided the misinformation;

• •

  the name of the company;

• •

  the approximate date in which the misinformation was provided; and

• •

  a description of what misinformation was provided.

The SEP duration begins the day the individual contacts SSA about being misinformed and ends on the last day of the month six months later.

There will be no premium surcharge when enrolled based on this SEP.

The individual’s coverage begins the first day of the month following the month of enrollment.

See HI 00805.277 Processing SEP Enrollments for processing instructions.

HI 00805.277 Processing SEP Enrollments