Georgia Medicare Enrollment Periods: IEP, GEP, SEPs, and How to Enroll

Miss your Medicare enrollment window in Georgia and you can pay a late penalty that lasts for life, unless a Special Enrollment Period or a Medicare Savings Program covers you.1 Miss it without one of those and you can also go months with no coverage at all. The federal framework under Section 1837 of the Social Security Act (42 USC 1395p) and 42 CFR Part 407 establishes a structured system of enrollment windows: the Initial Enrollment Period (IEP) at age 65 or upon disability eligibility, the General Enrollment Period (GEP) for those who missed their first chance, a series of Special Enrollment Periods (SEPs) for life circumstances like losing employer coverage or being affected by a government-declared disaster, and the Annual Election Period (AEP) for Medicare Advantage and Part D plan changes. Each window has its own start date, duration, coverage effective date, and penalty implications.2

Federal Authority: Section 1837 of the Social Security Act (42 USC 1395p) and 42 CFR Part 407

Coverage Pathways: Initial Enrollment Period (7 months around 65th birthday); General Enrollment Period (January 1 through March 31); Special Enrollment Periods (GHP, Exceptional Conditions, Equitable Relief, Termination of Medicaid)

2023 enrollment reforms: Under section 120 of the Consolidated Appropriations Act, 2021, GEP coverage now starts the month after enrollment (it was July 1 before January 2023)3

Exceptional Conditions SEPs (effective 2023): 42 CFR 407.23 (Part B) and 42 CFR 406.27 (premium Part A) created SEPs for Medicaid loss, employer or health-plan misinformation, release from incarceration, government-declared disasters, and other exceptional conditions4

Georgia Resources: Social Security Administration 1-800-772-1213; GeorgiaCares (SHIP) 1-866-552-4464; Medicare 1-800-MEDICARE5,6

In 2026 the rules look different than they did three years ago. Section 120 of the Consolidated Appropriations Act, 2021 (Public Law 116-260), effective January 1, 2023, eliminated the prior delay that pushed General Enrollment Period coverage to July 1, and now GEP coverage starts the first day of the month after enrollment. The same reforms had first passed the House as the BENES Act of 2020, but that standalone bill stalled in the Senate, so the law that governs your enrollment is section 120 of the CAA.3 The 2023 Exceptional Conditions Special Enrollment Period regulation (42 CFR 407.23), created by the same law at Section 1837(m) of the Social Security Act and effective January 1, 2023, added entirely new SEP categories for loss of Medicaid, employer or health-plan misrepresentation, formerly incarcerated individuals, government-declared disasters, and other exceptional conditions. None is automatic: you have to show you meet that SEP's conditions.4 A Georgian kept from enrolling by a declared disaster, such as Hurricane Helene in 2024, may qualify for the disaster SEP covered below.

This guide walks Georgia families through every enrollment pathway: the seven-month IEP window structured around the 65th birthday, the three-month GEP from January through March each year, the eight-month Group Health Plan SEP that protects beneficiaries retiring from job-based coverage, the new Exceptional Conditions SEP categories effective 2023, the Equitable Relief process under Section 1837(h) when federal employees provide incorrect information, the auto-enrollment process for those receiving Social Security retirement benefits or 24 months of SSDI, the Medicare Advantage Annual Election Period October 15 through December 7 and the MA Open Enrollment Period January 1 through March 31, the Part D enrollment periods including the monthly SEP for Extra Help recipients, and the coordination between Marketplace coverage and Medicare eligibility. We close with six worked examples, fifteen common enrollment mistakes, a comprehensive FAQ, and a contact list for Georgia families navigating these decisions.

The Federal Framework: Section 1837 of the Social Security Act

The statutory authority for Medicare Part A and Part B enrollment timing is Section 1837 of the Social Security Act, codified at 42 USC 1395p. This section was enacted as part of the original Medicare program in 1965 under Public Law 89-97 and has been amended multiple times. The implementing regulations are at 42 CFR Part 407, with detailed subsections covering each enrollment pathway.

Section 1837 establishes three primary enrollment periods for Part B: the Initial Enrollment Period under Section 1837(d), the General Enrollment Period under Section 1837(e), and Special Enrollment Periods under Section 1837(i), including the Group Health Plan SEP that lets beneficiaries with current employment coverage delay Part B enrollment without penalty. The companion Section 1838 (42 USC 1395q) governs coverage effective dates; its subsection (g) sets the start date for the exceptional-conditions SEPs.4

Section 1837(h) provides an equitable relief authority allowing Social Security to grant enrollment relief when federal employee error caused a beneficiary to miss an enrollment opportunity. This is a discretionary remedy and requires documentation of the federal error.

For Medicare Advantage and Part D, the framework is different. Section 1851 SSA governs MA enrollment with Annual Election Period and MA Open Enrollment Period rules, and Section 1860D-1 SSA governs Part D enrollment with similar but distinct timing.

Section 120 of the Consolidated Appropriations Act, 2021 reworked the system effective January 1, 2023: it removed the GEP coverage delay and added Section 1837(m), which lets the Secretary of Health and Human Services create SEPs for exceptional conditions.3 CMS then implemented that authority in one 2022 final rule, at 42 CFR 407.23 for Part B and 42 CFR 406.27 for premium Part A.4

Initial Enrollment Period (IEP): The 7-Month Window Around Age 65

The Initial Enrollment Period is the foundation of Medicare enrollment timing. Under Section 1837(d) of the Social Security Act and 42 CFR 407.14, the IEP is a seven-month window structured around the month a beneficiary turns 65 or, for those entitled to Medicare due to disability, around the 25th month of Social Security Disability Insurance cash benefits.

Structure of the 7-Month IEP

The IEP begins three months before the month of the beneficiary's 65th birthday, includes the birthday month itself, and ends three months after the birthday month. The total window is seven months.2

For example, a Georgia senior with a birthday on October 15, 2025 has an IEP that:

• Begins July 1, 2025 (3 months before October)
• Includes July, August, September (3 months before)
• Includes October (birthday month)
• Includes November, December, January 2026 (3 months after)
• Ends January 31, 2026

Coverage Effective Dates

For Part B (and Part A if you have to buy it), coverage effective dates depend on when within the IEP the beneficiary enrolls:2

• Enrollment during the 3 months before birthday month: Coverage starts the first day of the birthday month
• Enrollment during the birthday month: Coverage starts the first day of the month after birthday month
• Enrollment during the 3 months after birthday month: Coverage starts the first day of the month after enrollment

Premium-free Part A works differently: it starts the month you turn 65 no matter which IEP month you sign up in (the month before, if your birthday falls on the first).2 The month-after-enrollment start for late-IEP sign-ups comes from section 120 of the Consolidated Appropriations Act, 2021, and applies to people who became eligible for Medicare on or after January 1, 2023.3

Who Gets Auto-Enrolled

Beneficiaries who start receiving Social Security (or Railroad Retirement Board) benefits at least 4 months before turning 65 are automatically enrolled in both Part A and Part B, and their welcome package with the Medicare card is mailed about three months before coverage starts.6 For most people, the Part B premium is then deducted automatically from the monthly Social Security benefit.7

Beneficiaries receiving Social Security Disability Insurance are automatically enrolled in Medicare at the 25th month of SSDI cash benefits, regardless of age. The auto-enrollment letter and Medicare card arrive approximately three months before month 25.

Beneficiaries with ALS (amyotrophic lateral sclerosis) are auto-enrolled immediately upon SSDI entitlement without the 24-month wait, per Section 226(h) SSA. Beneficiaries with end-stage renal disease have specialized enrollment timing under Section 226A SSA, with coverage beginning the fourth month of dialysis (or earlier with home dialysis training or kidney transplant).8

Manual Enrollment Required

Beneficiaries who have delayed claiming Social Security retirement benefits must manually enroll in Medicare. This is increasingly common as more Americans delay Social Security to age 67 or 70 for higher monthly benefits. These beneficiaries must take affirmative action during the IEP to enroll.

Most workers still active at age 65 with employer health coverage also fall into the manual enrollment category. They may choose to delay Part B enrollment under the Group Health Plan SEP rules described below, but they must affirmatively coordinate that timing.

How to Enroll

Three primary enrollment pathways exist:

• Online at ssa.gov/medicare/sign-up (Medicare calls it the easiest and fastest way; you need a my Social Security account)
• Phone via Social Security 1-800-772-1213 (TTY 1-800-325-0778), which SSA now presents as a way to make an appointment6
• In person at a local Social Security field office in Georgia (field offices across the state)

Form CMS-40B is used for Part B enrollment. The form can be downloaded from cms.gov or completed online via the Social Security website.

General Enrollment Period (GEP): The Recovery Window

The General Enrollment Period is the backup window for beneficiaries who missed their IEP and do not qualify for a Special Enrollment Period. Under Section 1837(e) SSA and 42 CFR 407.15, the GEP runs from January 1 through March 31 of each calendar year.

Coverage Effective Date After the 2023 Reforms

Section 120 of the Consolidated Appropriations Act, 2021 made the biggest change here. Before January 1, 2023, GEP coverage was effective the July 1 following enrollment, regardless of when during the January-March window the beneficiary enrolled, which left a gap of three months or more with no Part B.3

Effective January 1, 2023, GEP coverage starts the first day of the month after enrollment:3

• January enrollment → February 1 coverage start
• February enrollment → March 1 coverage start
• March enrollment → April 1 coverage start

The reform shortened the wait, not the penalty: enrolling in the GEP does not by itself avoid the Part B late enrollment penalty.3

Late Enrollment Penalties

GEP enrollment typically triggers a Part B late enrollment penalty under Section 1839(b) SSA. The penalty is 10 percent of the standard Part B premium for each full 12-month period of delay between the IEP and the GEP enrollment. The penalty is permanent and applies for the beneficiary's lifetime. The two exceptions are qualifying for a Special Enrollment Period or for a Medicare Savings Program; creditable drug coverage is a Part D test and does not apply here.1

For example, a beneficiary who missed her IEP that ended in October 2024 and enrolls during the GEP in March 2026 has approximately 17 months of delay. The penalty calculation rounds down to full 12-month periods, so 17 months equals one complete 12-month period, or a 10 percent LEP.

At the 2026 standard Part B premium of $202.90 per month, a 10 percent LEP adds $20.29 per month, for a total monthly premium of $223.19. Over 20 years of Medicare coverage, this LEP would cost approximately $4,870.9,1

Coordination with Medicaid Buy-In

Beneficiaries who qualify for Medicaid Buy-In through QMB, SLMB, or QI under Section 1843 SSA and Section 1905(p) SSA have their Part B premium paid by Georgia Medicaid. Qualifying for a Medicare Savings Program also takes the Part B late enrollment penalty off the table: the penalty applies only to someone who missed the IEP and does not qualify for a Special Enrollment Period or a Medicare Savings Program.1 That makes Medicaid Buy-In enrollment particularly valuable for low-income Georgia seniors who delayed Part B enrollment due to misunderstanding or financial hardship.

Group Health Plan Special Enrollment Period (GHP SEP)

The most commonly used SEP is the Group Health Plan SEP, which CMS calls the SEP for the Working Aged and Working Disabled. It allows beneficiaries with health coverage based on their own or a spouse's current employment to delay Part B enrollment without incurring a late enrollment penalty.3

Structure of the GHP SEP

You can sign up in any month you are still covered by the current-employment plan. After the employment or the coverage ends, whichever comes first, you get eight more months. SSA and CMS describe the start of those eight months one month apart, so treat the earlier reading as your deadline, and Medicare.gov suggests signing up about a month before your current coverage ends to avoid a gap.3 This is the critical timing rule that creates the COBRA trap discussed below.

Requirements

To qualify for the GHP SEP, the beneficiary must satisfy three conditions:

1. The beneficiary or the beneficiary's spouse must have had current employment status with an employer providing the group health plan (or, for a disabled beneficiary under 65, a family member's current employment with a large group health plan)
2. The group health plan coverage must have been based on that current employment, not retiree status
3. The beneficiary must enroll in Part B while still covered or within the eight-month window

The SEP does not apply if the job-based coverage or the employment ends during your Initial Enrollment Period, or if your Medicare is based on End-Stage Renal Disease. If you are self-employed or your plan is not offered to everyone at the company, ask the insurer whether it counts as employer group health plan coverage before you rely on it.3

The Medicare Secondary Payer rules under Section 1862(b)(1)(A) and 1862(b)(1)(B) interact with these requirements. For a working aged beneficiary (age 65 or older) whose group health plan coverage is based on their own or their spouse's current employment status, the group health plan pays first and Medicare pays second when the employer has 20 or more employees. That threshold is also met by someone in a multi-employer plan where at least one participating employer has 20 or more employees (42 CFR 411.172(a)). If the employer has fewer than 20 employees and there is no multi-employer plan to pull the beneficiary over the line, Medicare generally pays first.10 That threshold decides who pays first, not whether you get the SEP. For disabled beneficiaries under 65, the threshold is different: the large group health plan pays primary when it covers employees of at least one employer that had 100 or more full- or part-time employees on at least half of its business days in the previous calendar year.11

The COBRA Trap

COBRA continuation coverage does NOT count as current employment-based coverage for GHP SEP purposes, and the end of COBRA does not open a new SEP.2

When a beneficiary's active employment ends, the GHP SEP clock starts immediately, even if the beneficiary elects COBRA continuation. The eight-month SEP window runs from the month after active employment ends, not from the month after COBRA ends. A beneficiary who elects 18 months of COBRA and then enrolls in Part B is approximately 18 months past the start of the GHP SEP and faces a 10 percent LEP for life.1

Retiree Coverage Does Not Count

Retiree health coverage from a former employer also does NOT count as current employment for GHP SEP purposes. Beneficiaries who retire and rely on retiree coverage without enrolling in Part B face the same penalty risk as COBRA-only beneficiaries.

The general rule: only health coverage based on actively employed status (the beneficiary or spouse currently working for the employer) qualifies for the GHP SEP protection.

Examples of GHP SEP Use

• Working aged employee retires at 67: Large-employer GHP coverage ends December 31, 2025. The eight-month SEP runs into summer 2026; because SSA and CMS count its start a month apart, the safe deadline is the end of July 2026. Employee enrolls in Part B February 2026 with no LEP.3
• Spouse of working aged employee: Spouse covered under employee's GHP loses coverage when employee's active employment ends. Same 8-month SEP applies.
• Disabled beneficiary under 65 with current spousal employment: Beneficiary covered under spouse's large-employer GHP. Spouse retires at 65. 8-month SEP for the disabled beneficiary begins month after spouse's active employment ends.

Exceptional Conditions SEP (Effective 2023)

The 2023 Exceptional Conditions SEP regulation created entirely new SEP categories under the authority of Section 1837(m) of the Social Security Act, added by section 120 of the Consolidated Appropriations Act, 2021. CMS codified them in one 2022 final rule, at 42 CFR 407.23 for Part B and 42 CFR 406.27 for premium Part A, effective January 1, 2023; the subsections cited below are the Part B text. None of these SEPs is automatic: you must show you meet its conditions. Coverage generally begins the first day of the month after enrollment. The late-enrollment penalty relief is conditional, too: the months you went without coverage drop out of the penalty only if you enroll before the SEP ends. Let it lapse and those months, including the months of the SEP itself, count against you.4 These SEPs cover Part B and premium Part A only; they do not extend Part D drug coverage deadlines.3

Categories of Exceptional Conditions

The regulation establishes the following categories of exceptional conditions that trigger SEP eligibility:

Loss of Medicaid (42 CFR 407.23(e)): Beneficiaries whose Medicaid eligibility is being terminated on or after January 1, 2023 get an SEP that starts when they are notified of the termination and ends six months after the coverage ends. They can also ask for Part B to be backdated to the date Medicaid ended, if they pay the premiums for that period.4 You are not eligible while you still have Medicaid, including a Medicare Savings Program, and have not received notice of an upcoming termination.3

Misrepresentation by an Employer or Health Plan (42 CFR 407.23(c)): When an employer, a group health plan, or a plan's agent or broker materially misrepresents or gives incorrect information about enrolling, and the beneficiary did not enroll because of it, the beneficiary has a six-month SEP beginning the day the individual notifies the Social Security Administration. You must show both points by documentation or a written attestation.4

Formerly Incarcerated Individuals (42 CFR 407.23(d)): Individuals who missed enrolling because they were in custody have an SEP that starts the day of release and ends the last day of the 12th month after the month of release, so it runs somewhat longer than 12 months from the release date itself. They can ask for coverage backdated up to 6 months (never before the month of release) if they pay the premiums for that period. People released to a halfway house are not considered incarcerated for this SEP.4

Government-Declared Emergency or Disaster (42 CFR 407.23(b)): Beneficiaries who were prevented from submitting a timely Medicare enrollment request by an emergency or disaster declared by a federal, state, or local government have an SEP. They must show they lived in the declared area during the period the declaration covers. The SEP begins on the earlier of the declaration date or the start date in the declaration, and ends six months after the declaration's end date (including any extensions).4

Other Exceptional Conditions (42 CFR 407.23(f)): A catch-all category CMS decides case by case, providing an SEP of no less than six months. You must show you missed an enrollment period because of an event or circumstance outside your control that prevented you from enrolling, and the condition must be judged exceptional.4 CMS says it will not grant this SEP for forgetfulness, lack of knowledge, or failure to pay premiums.3

Application Process

The beneficiary files an application with the Social Security Administration (Form CMS-10797) documenting the exceptional condition.3 Documentation requirements vary by category but typically include:

• For Medicaid loss: termination notice from Georgia DCH or DFCS
• For employer misrepresentation: written communication showing the misrepresentation
• For disaster: FEMA disaster declaration number and documentation of impact
• For incarceration: release documentation from corrections authority

SSA reviews the application and approves or denies. Appeal rights apply if the application is denied.

Equitable Relief Under Section 1837(h)

Section 1837(h) SSA and 42 CFR 407.32 let SSA or CMS grant equitable relief when your Part B enrollment or non-enrollment was unintentional, inadvertent, or erroneous because of the error, misrepresentation, or inaction of a federal employee or someone authorized to act for the federal government.12

When Equitable Relief Is Available

Equitable relief applies when:

• A federal employee (SSA, CMS, Medicare) provided incorrect information about enrollment timing
• A federal notice contained material errors
• A federal agency failed to inform the beneficiary of enrollment options
• The beneficiary reasonably relied on the federal misinformation to her detriment

Misinformation that reached you secondhand still counts: if an employer or insurer passed along something it got from a federal employee or agent, that also qualifies. Hardship or "good cause" alone does not; there has to be a government error, misrepresentation, or inaction that harmed your rights.12

Examples

• SSA provided incorrect IEP dates and beneficiary enrolled after IEP ended
• Medicare provided incorrect information about creditable coverage status
• Federal employee at SSA office misadvised beneficiary that she did not need Part B because of VA coverage
• SSA failed to send required enrollment notices before age 65

Process

The beneficiary files a written request with Social Security documenting:

• The specific federal error
• How the beneficiary relied on the misinformation
• What enrollment opportunity was missed
• The harm caused (LEP or coverage delay)

There is no time limit on granting relief. SSA makes a discretionary determination, and the remedy is whatever corrects the error: a special initial or general enrollment period, an entitlement period based on it, an adjustment of premiums, or another fix. The equitable relief decision itself cannot be appealed, though you can appeal something like the correctness of your entitlement date.12

SSDI Auto-Enrollment and Disability Medicare

Beneficiaries entitled to Medicare based on disability (rather than age 65) have specialized enrollment rules under Section 226 SSA.

The 24-Month Waiting Period

After receiving Social Security Disability Insurance cash benefits for 24 months, the beneficiary is automatically enrolled in Medicare Part A and Part B effective month 25. The auto-enrollment letter arrives approximately three months before month 25.

ALS Exception

Beneficiaries with amyotrophic lateral sclerosis receive immediate Medicare entitlement under Section 226(h) SSA without the 24-month wait. Coverage begins the first month of SSDI cash benefits.

ESRD Enrollment

Beneficiaries with end-stage renal disease receive Medicare under Section 226A SSA. The coverage begins:

• The fourth month of dialysis (standard 3-month waiting period)
• The first month if home dialysis training begins
• The month of kidney transplant

If you have Medicare only because of ESRD and also have group health plan coverage, there is a 30-month coordination period under Section 1862(b)(1)(C) during which the group health plan pays first; if Medicare was already your primary payer through age or disability, it stays primary.8 The job-based Part B SEP described above does not apply to Medicare based on ESRD.2

Opting Out of Part B at Age 65 Conversion

Disabled beneficiaries who reach age 65 transition from disability-based Medicare to age-based Medicare. If you turned down Part B while on disability-based Medicare, ask Social Security or GeorgiaCares before your 65th birthday how that transition affects your chance to enroll and any penalty.

Medicare Advantage and Part D Enrollment Periods

Medicare Advantage (Part C) and Part D have their own enrollment period framework under Section 1851 SSA and Section 1860D-1 SSA. These periods are distinct from the Part A and Part B enrollment periods discussed above.

Annual Election Period (AEP)

The AEP runs October 15 through December 7 each year under Section 1851(e)(3).2 During the AEP, beneficiaries can:

• Switch from one Medicare Advantage plan to another
• Switch from Medicare Advantage back to Original Medicare
• Switch from Original Medicare to Medicare Advantage
• Enroll in, change, or drop a Part D plan

Coverage from AEP elections is effective January 1 of the following year.

Medicare Advantage Open Enrollment Period (MA-OEP)

The MA-OEP runs January 1 through March 31 each year under Section 1851(e)(2)(C). This period is available only to those already enrolled in Medicare Advantage at the start of the year and allows one of the following changes:

• Switch from one MA plan to another
• Switch from MA back to Original Medicare with a Part D plan

Note that MA-OEP does NOT allow switching from Original Medicare to MA. Beneficiaries in Original Medicare switch to MA during the October 15 to December 7 period unless a Special Enrollment Period applies.2

Initial Coverage Election Period (ICEP)

The ICEP for Medicare Advantage aligns with the IEP for Original Medicare. New Medicare beneficiaries can enroll in an MA plan during their 7-month IEP.

Special Enrollment Periods for MA and Part D

42 CFR 422.62 (for MA) and 42 CFR 423.38 (for Part D) set out these SEPs. When certain events happen in your life, like a move or losing other insurance coverage, you may be able to change your Medicare health and drug coverage.2 Two that Georgia families use often:

• Extra Help and dual eligibility: full-benefit dual eligibles and anyone eligible for Extra Help can switch to a standalone Part D plan once a month13
• 5-star plan SEP: usable once per contract year, from December 8 through November 30, to switch to a plan with a 5-star quality rating, if one is offered in your area14

Part D Monthly SEP for Extra Help

The old quarterly Dual/LIS SEP, usable once in each of the first three quarters, is gone. Starting in 2025, CMS replaced it with a once-per-month SEP that lets full-benefit dual eligibles and anyone eligible for Extra Help (the Part D Low Income Subsidy) switch to a standalone Part D plan in any month. One exception: someone a plan has flagged as an at-risk beneficiary under its drug management program cannot use it while that flag stands.13 People in QMB, SLMB, or QI are automatically treated as eligible for Extra Help.15

Marketplace-to-Medicare Coordination

The transition from ACA Marketplace coverage to Medicare is a common source of confusion for Georgia families approaching age 65.

Termination Timing

Marketplace coverage does not end automatically when Medicare starts, so you have to end it yourself. Once you are eligible for premium-free Part A, even before you enroll in Medicare, you no longer qualify for Marketplace savings. Beneficiaries who keep Marketplace coverage after that point:

• Lose eligibility for premium tax credits and cost-sharing reductions
• Have to pay back any premium tax credit used when they file federal taxes
• Pay full price for the Marketplace plan16

Losing or ending Marketplace coverage does not open a Medicare Special Enrollment Period, so sign up for Medicare when you are first eligible.2

Best Practice

End Marketplace coverage before Medicare starts so the two don't overlap; you can report your Medicare start date on your Marketplace application up to 3 months ahead.16 For example, a beneficiary with a March 1, 2026 Medicare start date would end Marketplace coverage effective February 28, 2026.

Cost Comparison

The cost difference between Marketplace and Medicare can be significant. A 64-year-old in Atlanta receiving a large premium tax credit might pay only a modest net premium for a silver Marketplace plan. At Medicare, the same person pays the standard Part B premium of $202.90 per month, plus a Part D premium and supplemental coverage costs (Medigap or Medicare Advantage), before any low-income help.9

Georgia families approaching 65 should explore Medicare Savings Programs (QMB, SLMB, QI) and Part D Extra Help to mitigate this cost transition.

Coordination with Georgia Medicaid

Termination of Medicaid SEP

Under 42 CFR 407.23(e), Georgia seniors whose Medicaid is being terminated get an SEP that runs from the termination notice until six months after the coverage ends. Enroll within it and the months without Part B don't count toward a late enrollment penalty.4

Buy-In Coordination

Section 1843 SSA authorizes Georgia Medicaid to pay Medicare Part A and Part B premiums for beneficiaries enrolled in Medicaid Buy-In programs (QMB, SLMB, QI). Qualifying for a Medicare Savings Program also means no Part B late enrollment penalty.1

Georgia MSP applications are processed by DFCS through Georgia Gateway, but that is not the only door: an Extra Help application filed with Social Security also starts the MSP application unless you object, and SSA sends the data to Georgia Medicaid.17

Dual-Eligible Special Enrollment

Full-benefit dual eligibles (Medicare + Medicaid) have two monthly SEPs: one to switch to a standalone Part D plan, and one to join an integrated D-SNP that coordinates both programs.13

Georgia Resources for Enrollment Help

Worked Examples: Georgia Medicare Enrollment

Margaret 64 Atlanta: IEP Enrollment

Margaret lives in Atlanta and will turn 65 on October 15, 2025. She retired at 62 and has been on her husband's small-employer health plan (8 employees). Because her husband's employer has fewer than 20 employees and is not part of a larger multi-employer plan, Medicare pays first and his plan pays second once she is eligible.10 Skipping Part B would leave his plan paying only as a secondary payer, so she decides not to delay.

Margaret reviews her IEP timing:

• IEP begins July 1, 2025
• IEP includes July, August, September (3 months before birthday)
• Includes October (birthday month)
• Includes November, December, January 2026 (3 months after)
• IEP ends January 31, 2026

Margaret decides to enroll early to ensure coverage begins her birthday month. She visits ssa.gov/medicare in August 2025 and completes the online Medicare application. She enrolls in both Part A and Part B. Two weeks later she receives her Medicare card with effective date October 1, 2025.

Her estimated monthly costs (Part D and Medigap figures are illustrative and vary by plan):

• Part B premium: $202.90/month (2026 standard)9
• Part D plan: about $34/month
• Medigap Plan G: about $145/month
• Total: approximately $382/month

She does not face any LEP because she enrolled within her IEP. She also signs up with Atlanta's GeorgiaCares counselor for help comparing Part D plans and Medigap options.

Robert 66 Savannah: Employer Misinformation and a Missed SEP

Robert lives in Savannah and turned 65 in April 2024. He was working part-time at a small business (10 employees) with coverage through the company plan, and his employer told him he did not need Medicare because of that plan.

Robert left the job in March 2025, and his company coverage ended with it. He didn't realize that the end of job-based coverage starts an eight-month Special Enrollment Period, and that window closed in late 2025.3 He also learned that because his employer had fewer than 20 employees, Medicare should have been paying first all along, with the company plan paying second.10

Robert visits GeorgiaCares in February 2026. The counselor explains:

• His IEP ended July 31, 2024 (3 months after his April birthday month)2
• His job-based SEP ran out about eight months after his coverage ended
• The GEP (January 1 - March 31, 2026) is open, but enrolling through it alone could leave him with a late enrollment penalty
• Because his employer told him he didn't need Medicare, the Exceptional Conditions SEP for employer misrepresentation under 42 CFR 407.23(c) is the one to check first3

The counselor recommends filing the misrepresentation SEP request with Social Security, with documentation or a written attestation showing both that he didn't enroll because of what his employer told him and that the information was wrong, and filing before March 31 so the GEP is still open as a fallback.4

Robert files on March 15, 2026, attaching his employer's written assertion that he did not need Medicare. SSA approves the misrepresentation SEP, and his Part B starts April 1, 2026, the first day of the month after he enrolled. Because he enrolled within the SEP, the months he went without Part B are left out of the penalty calculation.4 His Part B premium is the standard $202.90/month with no penalty.9

Linda 66 Macon: GHP SEP From 500-Employee Firm

Linda lives in Macon and is 66 years old. She has been working full-time at a 500-employee firm with comprehensive group health coverage. Under Section 1862(b)(1)(A) SSA, her employer-based coverage is primary to Medicare because the employer has 20 or more employees and she is in current employment.

Linda did NOT enroll in Part B at age 65 because her GHP coverage was primary and she did not want to pay two premiums. This was a valid choice as long as she maintained current employment.

Linda decides to retire effective December 31, 2025. Her active employment ends that day. Her 8-month Group Health Plan SEP now starts running. SSA and CMS count its start a month apart, so she treats the earlier reading, which ends in July 2026, as her deadline.3

Linda files Form CMS-40B with documentation of her active employment dates (CMS-L564 from her employer) on February 10, 2026. SSA processes the application and her Part B coverage begins March 1, 2026, the first month after she signed up. No LEP applies because she enrolled during her GHP SEP.3

She also joins a Part D plan, using the Special Enrollment Period that can open when you lose other insurance coverage, and selects Medigap Plan G.2

Her estimated monthly costs (Part D and Medigap figures are illustrative and vary by plan):

• Part B premium: $202.909
• Part D plan: about $42
• Medigap Plan G: about $158
• Total: approximately $403/month

Linda also notes that she could have continued COBRA from her former employer for up to 18 months, but COBRA does NOT count as current employment for GHP SEP purposes. If she had elected COBRA and delayed Part B enrollment beyond 8 months, she would have faced a permanent LEP.

Charles 50 Augusta: SSDI Month 25 Auto-Enrollment

Charles is 50 years old and lives in Augusta. He developed a chronic condition in 2023 that prevented him from working. He applied for Social Security Disability Insurance and was approved with disability onset March 2023. Due to the standard 5-month SSDI waiting period, his cash benefits began September 2023.

Under Section 226 SSA, Charles is entitled to Medicare after 24 months of SSDI cash benefits. Month 25 of his SSDI = September 2025.

In approximately June 2025, Charles receives an auto-enrollment letter from Social Security explaining that his Medicare Part A and Part B will begin September 1, 2025. The letter includes a Medicare card and instructions for declining Part B if he has other coverage.

Charles has no other coverage, so he keeps both Part A and Part B. His Part B premium ($202.90/month in 2026) is automatically deducted from his SSDI benefit.9,7

Charles also explores Medicaid options because his SSDI income is modest. He qualifies for the Qualified Medicare Beneficiary (QMB) program through Georgia DFCS, which in 2026 covers a single applicant with monthly income up to $1,350 (the figure includes the standard $20 general income disregard).17 Once approved, Georgia Medicaid pays his Part B premium through the Section 1843 Buy-In, eliminating his out-of-pocket Medicare cost. He also qualifies for the Part D Low-Income Subsidy (Extra Help), which sharply reduces his prescription drug costs.15

Patricia 64 Columbus: Marketplace-to-Medicare Transition

Patricia lives in Columbus and is currently 64 years old. She has been enrolled in an ACA Marketplace silver plan for the past five years, paying a low net premium after a substantial premium tax credit. She will turn 65 in March 2026.

Patricia's IEP:

• Begins December 1, 2025 (3 months before March birthday)
• Includes December, January, February (3 months before)
• Includes March (birthday month)
• Includes April, May, June (3 months after)
• Ends June 30, 2026

Patricia enrolls in Medicare Part A and Part B in January 2026 (during the 3-months-before window). Her Medicare coverage begins March 1, 2026 (her birthday month).

She terminates her Marketplace coverage effective February 28, 2026. She specifically logs into Healthcare.gov and ends her coverage to avoid tax credit recapture issues.

Patricia's costs jump significantly. Where her subsidized Marketplace premium was modest, Medicare will cost her the 2026 standard Part B premium of $202.90 per month, plus a Part D plan and Medigap supplement, often several hundred dollars a month before any low-income help.9

Patricia is concerned about the cost increase. She visits GeorgiaCares and learns that with her modest retirement income of about $1,520 a month (Social Security retirement plus a small annuity), she may qualify for a Medicare Savings Program. Because her income is below the 2026 SLMB limit of $1,616 per month for a single applicant, she qualifies for the Specified Low-Income Medicare Beneficiary (SLMB) program under Section 1905(p)(3)(A)(ii).17

With SLMB enrollment through Georgia Medicaid, her $202.90 Part B premium is paid by the state, bringing her total Medicare cost back toward roughly what she paid on the Marketplace.17,9

Patricia files the SLMB application with DFCS and is approved effective March 2026.

Henry 73 Athens: Exceptional Conditions SEP After Hurricane Helene

Henry lives in Athens-Clarke County and is 73 years old. He kept working past 65 for a large employer and stayed on its group health plan, so he delayed Part B, a valid choice while he was still working. He retired in March 2024, his employer coverage ended March 31, and his eight-month job-based SEP started running.3

He planned to sign up that fall. In late September 2024, Hurricane Helene damaged his home badly enough that he spent four months displaced at a relative's home in another county, with his mail disrupted. By the time he got back on his feet, the job-based SEP had closed.

In February 2025 Henry visits GeorgiaCares. The counselor explains that missing the job-based SEP usually means waiting for the GEP and possibly owing a penalty, but that the disaster SEP under 42 CFR 407.23(b) may fit. It covers people who were prevented from submitting a timely Medicare enrollment request by a government-declared emergency or disaster, and it ends six months after the end date in the declaration. Henry has to show he lived in the declared area during the period the declaration covers, so the counselor's first step is confirming that his county was included.4

Henry files his request with Social Security, documenting:

• The disaster declaration that covered his county
• His home's damage and uninhabitable status
• His four-month displacement
• How the disruption kept him from enrolling in time

SSA approves the SEP, and his Part B starts the first day of the month after he enrolls. Because he enrolled within the SEP, the months he went without Part B are not counted toward a late enrollment penalty.4 The disaster SEP does not reach Part D, though. If Henry went 63 days or more without creditable drug coverage after his employer plan ended, a Part D penalty is figured separately, at 1% of the national base beneficiary premium for each full month without coverage.1

15 Common Georgia Medicare Enrollment Mistakes

1. Assuming Medicare auto-enrolls at 65 for everyone. Only people already getting Social Security (or Railroad Retirement) benefits at least 4 months before 65, or SSDI for 24 months, are auto-enrolled. Workers who delay Social Security must manually enroll.6

2. Confusing IEP with AEP. The IEP is for new Medicare beneficiaries enrolling in Part A and Part B. The AEP (October 15-December 7) is for existing Medicare beneficiaries making Medicare Advantage and Part D plan changes.

3. Believing COBRA counts as current employment for GHP SEP. COBRA does NOT count. The 8-month SEP clock starts when active employment ends, regardless of COBRA continuation.2

4. Assuming retiree coverage qualifies for GHP SEP. Retiree coverage does NOT count as current employment. Only active employee coverage qualifies.

5. Mixing up who pays first with whether you can delay. The 20-employee rule decides whether Medicare or a working-aged employer plan pays first, not whether you get the job-based SEP.10 But that SEP only covers coverage based on current employment, and Medicare.gov tells the self-employed and people whose plan isn't offered to everyone at the company to check with the insurer, and if it isn't employer group health plan coverage, to sign up at 65. Don't wait for a GHP SEP window that will never open.3

6. Failing to end Marketplace coverage when Medicare-eligible. It doesn't end on its own, and premium tax credits used after you're eligible for premium-free Part A have to be paid back at tax time.16

7. Not requesting Equitable Relief when federal error caused enrollment failure. Section 1837(h) provides discretionary relief for federal employee errors, with no time limit. File a written request with documentation.12

8. Missing the 8-month GHP SEP deadline. The SEP is calendar-based, not based on when the beneficiary realizes she should have enrolled. Track the deadline carefully.

9. Not enrolling in Part D when LIS-eligible. LIS (Extra Help) eligibility under Section 1860D-14 SSA significantly reduces Part D costs. Many low-income Georgia seniors don't realize they qualify.

10. Confusing MA-OEP (January-March) with AEP (October-December). The MA-OEP allows MA enrollees one switch back to Original Medicare or to another MA plan. It does NOT allow switching from Original Medicare to MA.

11. Failing to use the Exceptional Conditions SEP when applicable. The 2023 rules at 42 CFR 407.23 (Part B) and 406.27 (premium Part A) created new SEP categories for Medicaid loss, employer or health-plan misrepresentation, release from incarceration, government-declared disasters, and other exceptional conditions. None is automatic, and the penalty relief holds only if you enroll before the SEP ends.4

12. Not coordinating Buy-In with Medicaid enrollment. QMB enrollment triggers automatic Part B Buy-In under Section 1843, paying the Part B premium. Many beneficiaries don't apply for QMB because they don't realize the savings.

13. Assuming Part D LEP is the same as Part B LEP. Part B LEP is 10 percent per 12 months. Part D LEP is 1 percent per month (12 percent per year). They are calculated separately.1

14. Missing the 4th-month coverage start for ESRD-based Medicare. ESRD beneficiaries should plan for the 3-month dialysis waiting period or use home dialysis training for earlier coverage.

15. Failing to enroll in Part B during GHP SEP because employer says coverage is creditable. Employer "creditable coverage" applies to Part D, not Part B. Part B has separate enrollment rules and the employer's creditable coverage statement is irrelevant.

Quick Reference

Initial Enrollment Period (IEP): 7 months around 65th birthday or month 25 of SSDI General Enrollment Period (GEP): January 1 - March 31 each year (coverage starts month after enrollment) Group Health Plan SEP: any time while covered through current employment, then 8 months after the employment or that coverage ends, whichever is first (not COBRA end)3 Annual Election Period (AEP) for MA and Part D: October 15 - December 7 MA Open Enrollment Period (MA-OEP): January 1 - March 31 (existing MA enrollees only) Exceptional Conditions SEP: 6 months for most categories under 42 CFR 407.23; the incarceration SEP runs to the end of the 12th month after the month of release4 Equitable Relief: Discretionary, file with SSA documenting federal error12 Termination of Medicaid SEP: from the termination notice until 6 months after Medicaid ends4 Part B LEP: 10 percent per 12 months delay, permanent; no penalty if you qualify for a Special Enrollment Period or a Medicare Savings Program Part D LEP: 1 percent per month delay, permanent; generally no penalty if you had creditable drug coverage or you qualify for Extra Help1

Learn More

Find personalized help navigating Georgia Medicare enrollment at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.