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Tag: Special Enrollment Period

  • Administration expands Medicare special enrollment periods

    Administration expands Medicare special enrollment periods

    Most people enroll in Medicare in the three months before their 65th birthday month so that their coverage begins on the first day of their birthday month. But, some people miss this initial enrollment period and often pay a penalty for delaying their enrollment. A new Biden administration rule gives more people the right to enroll during a special enrollment period, eliminating penalties for late enrollment.

    As of January 1, 2023, more people who do not enroll in Medicare at 65 will be eligible for a special enrollment period, ending coverage delays and penalties for late enrollment. Without this change, these people would only be eligible to enroll in Medicare during the General Enrollment Period, between January and March of each year. They also would need to wait several months after enrolling for their Medicare coverage to begin. And, they would pay a 10 percent Part B premium penalty for each year they delayed enrollment in Medicare Part B.

    A special enrollment period (SEP) will be available to people who did not enroll in Medicare because of exceptional conditions. As of January 1, 2023, people affected by a disaster or government-declared emergency, people whose employer or health plan materially misrepresented information regarding timely enrollment, people who were in prison, and people whose Medicaid coverage ended after the COVID public health emergency ends will be eligible for a special enrollment period.

    In addition, some people who have had a kidney transplant and would lose Medicare coverage will have a new immunosuppressive drug benefit, giving them immunosuppressive drug coverage.

    If you need help enrolling in Medicare or have questions about your coverage, contact your State Health Insurance Assistance Program through www.shiphelp.org. 

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  • CMS proposes to expand access to Medicare benefits

    CMS proposes to expand access to Medicare benefits

    As anyone who has spent time trying to navigate Medicare knows, the rules are too often complicated and whacky. The Centers for Medicare and Medicaid Services (CMS) plans to fix some of the whackier rules and expand access to Medicare benefits. The proposed new rules would eliminate many of the waiting periods people must endure in order to have Medicare coverage.

    If finalized, the proposed rules would improve Medicare enrollment and eligibility, expanding coverage to older and disabled Americans. Right now, people who sign up for Medicare during the three months after they turn 65, must wait two or three months before their coverage begins. And, everyone who enrolls in Medicare during the annual General Enrollment Period between January and March must wait until July 1 for their coverage to begin.

    Under the proposed rules, everyone who enrolled in the three months after their 65th birthday month, during the Initial Enrollment Period, would be covered the month after they enrolled. And, everyone who signed up for Medicare during the General Enrollment Period–every January through March–would also be covered the month after they enrolled.

    In addition, CMS is proposing special enrollment periods to protect people who delay enrolling because of a natural disaster or because their employer or health plan misled them about the Medicare enrollment rules. Special enrollment periods would also extend to people losing Medicaid coverage and to others on a case-by-case basis because of exceptional circumstances beyond their control.

    The rules would reduce the number of people eligible for Medicare who are uninsured awaiting coverage. The rules would also protect more people from having to pay a penalty for failing to enroll in Medicare Part B when they are first eligible. Right now, people who do not sign up when they are first eligible pay a 10 percent Part B premium penalty for every year they delay enrolling.

    “Health care is not just about mending bones or dispensing pills. It’s about giving people peace of mind that comes with having coverage when you need it,” said U.S. Health and Human Services Secretary Xavier Becerra. “That’s why we’re proposing this rule today to help reduce delays, eliminate gaps, and expand access to care for people with Medicare.”

    The rules are designed to support President Biden’s Executive Orders on Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government and Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage.

    For free health insurance counseling from State Health Insurance Assistance Programs (SHIPs), visit shiptacenter.org or call 1-800-MEDICARE for your SHIP’s phone number.

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