CMSFORM.ORG – CMS-10797 – Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) – Are you or a loved one facing exceptional circumstances that have affected your ability to enroll in Medicare Part A and Part B? If so, there may be hope yet. The Centers for Medicare & Medicaid Services (CMS) has made provisions for special enrollment periods (SEPs) to help those who face unique situations. One such SEP is CMS-10797, which allows individuals to apply for enrollment in Part A and Part B outside of the standard enrollment period due to exceptional circumstances beyond their control.
In this article, we’ll explore what qualifies as exceptional circumstances under CMS-10797 and how you can go about applying for this special enrollment period.
Download CMS-10797 – Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)
| Form Number | CMS-10797 |
| Form Title | Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) |
| Published | 2022-03-31 |
| O.M.B. | 0938-1426 |
| File Size | 121 KB |
What is a CMS-10797?
CMS-10797 is an application form used by the Centers for Medicare and Medicaid Services (CMS) to determine eligibility for a special enrollment period (SEP) in Medicare Part A and Part B. This SEP is granted to people who experience exceptional circumstances that prevent them from enrolling in Medicare during the standard enrollment period. The CMS-10797 form allows individuals to request an SEP due to exceptional circumstances such as natural disasters, hospital errors, and other unforeseen events.
The CMS-10797 form requires detailed information about the individual’s situation and documentation supporting their claim of exceptional circumstances. The completed form must be submitted along with any required supporting documents within 60 days of the qualifying event. Once received, CMS will review the application and determine if the individual qualifies for an SEP.
It’s important to note that not all individuals who experience exceptional circumstances will qualify for an SEP through this application process. However, those who do qualify may be able to enroll in Medicare outside of the standard enrollment periods, which can provide important healthcare coverage when it’s needed most.
Where Can I Find a CMS-10797?
If you are looking for a CMS-10797 form, there are several ways to obtain it. Firstly, you can download the form from the official Medicare website. The website provides downloadable versions of various forms, including the CMS-10797. Alternatively, you can visit your local Social Security office and request a copy of the form in person.
It’s essential to note that not everyone qualifies for an exceptional circumstance special enrollment period (SEP). This type of SEP is only available if you missed your initial enrollment period because of circumstances beyond your control. Some examples include hospitalization or illness preventing you from enrolling within the seven-month window after turning 65.
Overall, obtaining a CMS-10797 form is easy and straightforward. If you qualify for an exceptional circumstance SEP under Medicare Part A and B, fill out this application to enroll in coverage during one of these periods outside the standard enrollment timeline.
CMS-10797 – Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)
CMS-10797 is an application form that Medicare beneficiaries can use to request a Special Enrollment Period (SEP) if they have experienced exceptional circumstances. The SEP allows individuals to enroll in or switch their Medicare coverage outside of the traditional enrollment periods.
To qualify for the SEP, individuals must have experienced exceptional circumstances that prevented them from enrolling in Medicare during their initial enrollment period or during a general enrollment period. Some examples of exceptional circumstances include hospitalization, natural disasters, errors made by federal employees, or changes in Medicaid eligibility.
It’s important to note that the CMS-10797 application does not guarantee approval for a SEP; each case is evaluated on its own merits. Individuals who believe they qualify for a SEP due to exceptional circumstances should fill out the form and submit it as soon as possible.
CMS-10797 – Example
