Changes to Medicare Enrollment Rules Start January 1st!

Starting January 1, 2023, changes to simplify Medicare enrollment and reduce gaps in coverage take effect. The changes were signed into law as part of the Consolidated Appropriations Act of 2021. The Centers for Medicare & Medicaid Services (CMS) issued a final rule on October 28, 2022 to implement the following key provisions of this law.

Please note that changes detailed below focus on enrolling in Medicare Part B, but also apply to people enrolling in Medicare Part A with a premium. Keep in mind that most people get Medicare Part A without having to pay any monthly premium. Everyone has a Medicare Part B premium, but some people with limited incomes and resources qualify for the premium to be paid by Medicaid through the Medicare Savings Programs

Changes to the Initial Enrollment Period

When people first become eligible for Medicare Part B, they have a seven-month Initial Enrollment Period (IEP) to sign up for Medicare.  The seven-month period includes the three months before they turn 65, the month of their 65th birthday, and the three months after their birthday month.  Before this rule change, if someone enrolled in Medicare Part B during the three months after their 65th birthday, they would have a delay in coverage of one to three months, depending on when they signed up. 

The new rule eliminates that delay for people who enroll in Medicare during the three months after the month of their 65th birthday.  Going forward, people who sign up during any of those three months after their 65th birthday will have their Medicare coverage start on the 1st of the month following the month when they enroll. 

Example: Lydia turns 65 in January 2023 but waits to enroll in Medicare Part B until March.  Her Medicare coverage will start on April 1st.  Under the old rules, Lydia’s Medicare wouldn’t have started until June 1st.

Changes to the General Enrollment Period

Each year, individuals who did not sign up for Medicare when they were first eligible can enroll in Part B during the General Enrollment Period, which runs from January 1st through March 31st.  Under the former rules, coverage for those who enroll during the General Enrollment Period would not start until July 1st.

Under the new policy, if someone enrolls during the General Enrollment Period, their coverage will begin the first of the following month. 

Example:  Ernesto did not enroll in Medicare Part B when he was first eligible and signs up in January 2023.  His coverage will begin February 1st.  Under the old rules, he would have had to wait until July 1st for his Part B coverage to begin.

New Special Enrollment Periods for People who Missed their Initial Enrollment Period

The Consolidated Appropriations Act of 2021 legislation gave CMS the authority to create new Special Enrollment Periods (SEPs) to enroll in Medicare Parts A and B for individuals who meet certain exceptional conditions.  (CMS already had the authority to do this for Medicare Parts C and D).  Using this authority, CMS created five new Special Enrollment Periods to allow people who miss or missed their Initial Enrollment Period due to the following exceptional circumstances to enroll in premium Medicare Part A and Medicare Part B without having to wait for the General Enrollment Period and without any late enrollment penalty.

Individuals who lose Medicaid coverage

This Special Enrollment Period applies to people who lose their eligibility for Medicaid after January 1, 2023.  People losing Medicaid will have a six-month SEP from the date their Medicaid eligibility ends to enroll in Medicare without penalty, and the SEP can be used at any time after the person is notified that they will be losing their Medicaid eligibility.  People using this SEP can elect to receive up to six months of retroactive coverage back to the date of Medicaid termination, provided they pay the premiums for the months of retroactive coverage.

Formerly incarcerated individuals

This Special Enrollment Period applies to people who became newly eligible for Medicare while they were incarcerated and failed to enroll, and also to people who were previously enrolled in Medicare but lost it during their incarceration.  People lose their coverage while incarcerated because they choose to drop their Part B coverage (since Medicare doesn’t cover their care while they are incarcerated) or because they cannot afford to keep paying their Part B premium.  The new rule provides a 12-month SEP from the date of release from incarceration to enroll.  A person using this SEP can choose to receive up to six months of retroactive coverage, provided they pay the premiums for those months.

Individuals impacted by an emergency or disaster

This Special Enrollment Period is for people who missed their IEP because they were impacted by certain government-declared emergencies or disasters.  To qualify, the person (or their health care decision-maker) must live in (or have lived in at the time) the area impacted by the emergency or disaster.  The SEP will begin on the date an emergency or disaster is declared and ends 6 months after the declaration has ended.

Individuals who experienced a health plan or employer error

This Special Enrollment Period is for people who did not enroll in Medicare during their IEP because they received misinformation from their employer or group health plan.  The SEP starts on the date they notify Social Security of the error and lasts for six months.  People will be allowed to provide a written attestation to document the misinformation they received if they do not have other proof. 

Other exceptional conditions

This catch-all will allow CMS to provide a minimum six-month Special Enrollment Period on a case-by-case basis to people with other extenuating circumstances that caused them to miss their IEP, the GEP, or other SEPs to enroll in Medicare Part A or B.

New Part B Immunosuppressive Drug Benefit

The Consolidated Appropriations Act of 2021 also created a limited Part B benefit that only covers immunosuppressive drugs for people who have had a kidney transplant. This new benefit is called Part B-ID. People with End Stage Renal Disease (ESRD), and who are on dialysis or who have had a kidney transplant, qualify for Medicare regardless of their age or if they are on Social Security Disability benefits. ESRD Medicare coverage ends three years (36 months) after a successful kidney transplant unless someone is eligible for continued Medicare coverage because they are over age 65 or because they have been receiving Social Security Disability benefits for at least two years.

People who are only entitled to Medicare based on ESRD can face challenges getting their anti-rejection medications, called immunosuppressive drugs, after their Medicare coverage ends. This can jeopardize the continued success of their transplant. This new benefit will help people keep coverage for these important medications when they do not have any other health coverage. 

To qualify for the Part B-ID benefit, someone cannot have, or expect to get, other health insurance coverage for their immunosuppressive drugs. Coverage under the new Part B-ID benefit starts January 1, 2023. For coverage to start on this date, people have to sign up before December 31, 2022. Otherwise, Part B-ID coverage will start the month after someone signs up. People can enroll by calling Social Security at 1-877-465-0355. If an individual enrolls in the Part B-ID benefit and later gets other health insurance, they must notify Social Security within 60 days of the new coverage starting. People can apply for the Part B-ID benefit if they have other health coverage that ends.

People who get the Part B-ID benefit will pay the yearly Part B deductible and 20% coinsurance for their immunosuppressive drugs. Individuals with limited incomes and resources can qualify for a Medicare Savings Program (also called “buy-in” in Pennsylvania) to help with these costs.

More information about the Part B-ID benefit can be found here.

People with questions about these changes or who need help enrolling in Medicare are encouraged to call PA MEDI at 1-800-783-7067.