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New Rules to Make Enrolling in Medicare Easier

Are you about to become eligible for Medicare? It’s very important to understand when to enroll and make changes to your coverage. If you miss deadlines, you may be paying lifetime penalties.

On April 22, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule to simplify Medicare enrollment, create new Special Enrollment Periods, and expand Part B coverage for certain people with End-Stage Renal Disease.

How Do Current Medicare Enrollment Periods Work?

There are four key times when someone can enroll in Medicare and/or make changes to their Medicare coverage. These are called “enrollment periods:”

  1. Initial Enrollment Period (IEP) – when you are first eligible for Medicare
  2. General Enrollment Period (GEP) – when you can sign up if you didn’t sign up during your IEP
  3. Annual Open Enrollment Period – when you can make changes each year
  4. Special Enrolment Periods (SEPs) – when you get special chances to make changes (e.g., when you move or leave a job)

Presently, if someone enrolls in Medicare during the last three months of their IEP or during the GEP, their Medicare coverage does not begin until several months later. For example:

  • Ian turns 65 in May, so his 7-month IEP is from February 1 until August 31. If he waits until August to enroll in Medicare, his coverage won’t begin until November 1, and may result in him not having health insurance coverage for several months.
  • Rose has just been diagnosed with cancer. She is 69 and although she has Medicare Part A, she never enrolled in Part B because she had always been healthy and didn’t want to pay for it. She has no other health insurance. It is August and Rose decides that she needs Part B coverage. Rose must wait until the next GEP (January 1-March 31) to enroll. Even if Rose enrolls on January 1, her Part B coverage will not start until July 1. This means Rose will go an additional 11 months without coverage under Part B, and she will face late enrollment penalties for the rest of her life.

How Would the Enrollment Periods Change?

If the rule is finalized, beginning January 1, 2023, if someone enrolls in Medicare during the last three months of their IEP or during the GEP, their coverage will begin the first day of the next month.

This will help people avoid a gap in their health insurance coverage, and potentially lower the amount of any late enrollment penalties someone may have to pay.

So, looking back at the examples above:

  • If Ian waits until August to enroll in Medicare, his coverage will begin on September 1, instead of November 1, giving him two more months of coverage.
  • While Rose will still need to wait until the next GEP to enroll in Part B, her coverage will start on February 1, instead of July 1, giving her five months of coverage she would not get under current rules.

What are the New Special Enrollment Periods?

CMS has proposed adding five new SEPs for the following situations:

  • Individuals who missed an enrollment opportunity because they were impacted by an emergency or disaster declared by a federal, state, or local governmental entity.
  • Individuals who can show that their employer or health plan materially mispresented information relating to Medicare enrollment.
  • Individuals whose Medicaid eligibility has been terminated.
  • Individuals who have been released from correctional facilities.
  • Other exceptional circumstances beyond someone’s control, as evaluated on a case-by-case basis.

Do You Have End-Stage Renal Disease (ESRD)?

If someone is eligible for Medicare solely based on having ESRD (i.e., and not based on age or disability), their coverage typically extends 36 months after a kidney transplant. The proposed rule allows someone with ESRD who has no other health coverage to enroll in Part B after the 36-month extension for the limited purpose of having coverage for immunosuppressive drugs necessary following their transplant.

Stay tuned to learn if this rule is finalized and when it will go into effect…

Do You Want to Learn More About Medicare Enrollment?

For more information about Medicare enrollment and the current rules, see our Quick Guide to Medicare Enrollment or our animated video entitled When to Enroll in Medicare. For more information about Medicare, visit our Health Insurance Resource Hub.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through eventsmaterials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

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