Many new Medicare enrollees could qualify faster for the insurance under a proposed rule that would become effective January 1, 2023.
The Centers for Medicare & Medicaid Services (CMS) announced April 22 that the proposed rule would allow coverage to start faster for people who enroll after the month they turn 65. The proposed rule implements sections of the Consolidated Appropriations Act, 2021 that simplify Medicare enrollment and extend coverage of immunosuppressive drugs for kidney transplant patients.
People generally get a seven-month window to initially enroll in Medicare: in the three months before their 65th birthday month, the month of their birthday, and three months after their birthday month. Under current rules:
• If an individual enrolls during any of the first three months of their initial enrollment period (IEP), their coverage will be effective at the start of the month in which they turn 65.
• If an individual enrolls during their 65th birthday month, their coverage will be effective the month after they sign up.
• If an individual enrolls during any of the last three months of their IEP, their coverage will be effective two to three months after they sign up.
• If an individual misses their IEP and enrolls during the general enrollment period (GEP), which runs from January 1 through March 31 every year, enrollments are effective July 1.
The 2021 act mandated that beginning January 1, 2023, Medicare coverage will become effective the month after enrollment for individuals enrolling in the last three months of their IEP or in the GEP, reducing any potential gaps in coverage.
The 2021 law also allows CMS to establish special enrollment periods for individuals meeting exceptional conditions so they don’t have to wait for the general enrollment period or face late-enrollment penalties.
In the rule proposed to take effect January 1, CMS would establish special enrollment periods for individuals who:
• Were impacted by a disaster or other emergency declared by a federal, state, or local government entity.
• Can demonstrate that their employer or health plan materially misrepresented information related to the time for enrolling in Medicare.
• Are released from correctional facilities.
• Have been terminated from Medicaid eligibility.
• Can demonstrate circumstances beyond their control that prevented them from enrolling at other times.
The proposed rule, which is being published in the Federal Register on April 27, would also provide Medicare immunosuppressive drug coverage longer for certain individuals who have had a kidney transplant.