The 2022 Consolidated Appropriations Act made sweeping changes in Medicare enrollment rules.
In October, the Centers for Medicare and Medicaid Services announced the regulations needed to implement the changes which take effect January 1, 2023. The changes will help some seniors get special enrollment periods(SEP) for Medicare Part B coverage, albeit they missed their initial enrollment periods. The SEPs could keep eligible clients from incurring Medicare Part B late fees.
Question: What are the new Medicare special enrollment period rules, and who do they apply to?
Answer: To understand the new special enrollment period rules, or SEP rules, you would like to know basic Medicare program terminology.
Medicare Part A is that the Original Medicare program that covers the value of inpatient hospitalization. Medicare Part B covers physician services and outpatient hospitalization. Stand-alone Medicare Part D prescription plans cover drugs, and Medicare Advantage plans typically include Part A, Part B and Part D coverage.
Most Medicare-eligible citizens use an initial enrollment period,(IEP), to check in for full Medicare coverage, including Part B coverage. The IEP includes the three months before a client’s 65th birthday, the month of the client’s 65th birthday and therefore the month after the client’s 65th birthday, or, for a client who continues to possess employer-sponsored health coverage after age 65, the eight-month period after loss of employer or group plan coverage.
Clients who are eligible for Medicare Part B coverage during the IEP can get the coverage without incurring any penalties. Some late enrollees might qualify for a special enrollment period, or SEP. Other clients who miss enrolling during the IEP period must wait to register until subsequent general enrollment period (GEP) which occurs between January 1 and March 31, 2023 While clients await a subsequent GEP, they'll accrue a late Medicare Part B enrollment fee. Affected clients must pay the late fee monthly for the rest of their time as a Medicare beneficiary; for many late enrollees, this suggests the remainder of their lives. Clients could enroll in stand-alone Medicare Part D prescription plans and Medicare Advantage plans during other enrollment periods, and do so without paying a fee, but Part D provides prescription coverage only, and Medicare Advantage plans don't precisely mirror Original Medicare.
2023 Changes To Medicare Jan.1, 2023, brings another option: Eligible seniors may immediately assess for full Medicare plans during SEPs if they meet certain conditions. Clients could qualify for the new SEPs if:
Have recently been released from incarceration.
Were recently involved a disaster or government-declared emergency.
Did not apply during the initial period due to errors by their employer or private health plan administrators associated with timely enrollment. The senior must show that one among these entities was in error for the enrollment failure.
If Medicaid coverage terminates after the COVID-19 public health emergency declaration ends, or on or after Jan. 1, whichever comes first).
Or meet other conditions which will be evaluated on a case-by-case basis, when circumstances out of their control prevent them from enrolling.
Seniors who leverage special enrollment will not be assessed the Part B fees for the duration of their enrollment. At first glance, a number of these provisions can seem complicated, especially for beneficiaries who are unacquainted Medicare and as a result is helpful for them to consult a Medicare specialist. The overarching goal of special enrollment is to stop seniors from falling into so-called “coverage gaps,”. Many are stuck without insurance for weeks or maybe months because they lost coverage cannot not afford to get a replacement private plan, then had wait for the GEP to apply for Medicare. Slated to start the New Year, these changes are undeniably for the better to make coverage more accessible and affordable for beneficiaries. Author: Monica Ross-Williams, MBA; LIA
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