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Dear Avisery Members,
Beginning in 2023, new Medicare special enrollment periods (SEP) became available for beneficiaries to use in exceptional circumstances that allow them to enroll in Part A and/or Part B if they did not enroll when first eligible for Medicare. One of these new SEPs is for individuals who lost or will lose Medicaid on or after January 1, 2023. Avisery is interested in hearing from professionals working with clients who are experiencing difficulties utilizing this SEP because they have a Medicaid Spenddown.
For a complete list and description of all the new available SEPs, please refer to a previous Avisery Alert: https://conta.cc/3YkquyS.
Background
Avisery would like to highlight the new SEP that coordinates with termination of Medicaid coverage. It provides individuals the opportunity to enroll in Medicare if they did not do so during a previous enrollment period and lose Medicaid on or after January 1, 2023. This SEP begins once an individual is notified of an upcoming Medicaid termination and ends six months after Medicaid is terminated. Individuals eligible to use this SEP do not have to pay Medicare late enrollment penalties.
Some individuals may have delayed enrolling in Medicare while on Medicaid because they did not realize they had to and were unaware of the implications of not enrolling, or because they could not afford the Medicare premiums. This new SEP is especially beneficial for individuals who go through the redetermination process during the Medicaid PHE (Public Health Emergency) Unwinding and learn that they no longer qualify.
To apply for the SEP, the individual must complete an application, include a notice from Medicaid or a Medicaid health plan that lists their termination date, and submit it to the Social Security Administration (SSA). If the individual does not submit a notice, SSA will attempt to contact the Medicaid office to confirm the individual lost Medicaid. The SEP application can only be mailed or dropped off to the local SSA office and cannot be submitted electronically. We suggest that individuals take detailed notes of the process, including when the application was mailed or dropped off at their local SSA office and make a copy for their records.
Using the Medicare SEP for Termination of Medicaid? We Want Your Feedback!
In Illinois, however, individuals eligible for the AABD Medicaid category (Aid to the Aged, Blind, or Disabled) and who no longer qualify for Medicaid because they are over income and/or assets do not receive a notice stating they are being terminated and instead are placed in Medicaid Spenddown.
SSA’s policy is unclear and does not specify if a spenddown notice will suffice as notice of Medicaid termination. (Note that if the individual meets their Medicaid spenddown, their Medicaid will be active and they may not be able to use this SEP.) As a result, Avisery encourages individuals who apply for this SEP to let us know about their experience with the process. We are hopeful that applications for this SEP will be processed timely and without issue. However, please contact us at avisery@ageoptions.org if you are working with a client who experiences difficulty using this SEP. We would also appreciate hearing of any stories about people on Medicaid Spenddown who successfully use this SEP. Avisery is collecting feedback and comments about this particular SEP and will share any findings with the Centers for Medicare and Medicaid Services (CMS).
Resources:
SEP Application for Medicare Part A and Part B Exceptional Conditions:
https://www.cms.gov/files/document/application-medicare-part-part-b-special-enrollment-period-exceptional-conditions.pdf
SSA policy for SEP of Medicaid Termination: https://secure.ssa.gov/poms.nsf/lnx/0600805385
If you have any questions, please feel free to email avisery@ageoptions.org
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