|
Dear Avisery Members,
Medicare has finalized five new Part B Special Enrollment Periods (SEP’s), which will be available to beneficiaries beginning January 1st, 2023. On November 3rd, 2022, the Center for Medicare and Medicaid Services (CMS) issued a final rule, implementing the Consolidated Appropriations Act of 2021 (CAA). Section 120 of the act (“Beneficiary Enrollment Simplification”) mandates the new SEP’s and eliminates Initial Enrollment Period (IEP) and General Enrollment Period (GEP) coverage delays. (Link is to a recent Avisery alert on this subject.)
Background
“Special Enrollment Periods” (SEP’s) allow someone to enroll into Medicare outside of the traditional enrollment periods. An individual who uses an SEP to enroll in Medicare will not be charged a late enrollment penalty. There are currently limited opportunities for beneficiaries to enroll in Part B using an SEP. The most common Part B SEP is for people who declined Medicare Part B because they were insured through their or their spouse’s active employment.
Beginning in 2023, five new SEPs will be available that will allow individuals to enroll into Part B if they experience an exceptional circumstance:
-
SEP for Individuals Impacted by an Emergency or Disaster declared by a federal, state, or local government entity:
- Person could not enroll on time due to a disaster or emergency that was declared in the area where the person resided.
- They must submit proof to Social Security Administration (SSA) that they or their authorized representative resided in the area during the time of the emergency declaration.
- SEP lasts 6 months from the date that the emergency was declared to have ended.
-
SEP for Health Plan or Employer Error:
- Person failed to enroll due to incorrect information provided by their employer or group health plan.
-
They must provide documentation and/or self-attestation to SSA that the incorrect information was given on or after January 1, 2023, and that it caused the person to delay Medicare enrollment.
-
SEP lasts 6 months from the date that the individual informs SSA of the employer error.
-
SEP for Formerly Incarcerated Individuals:
- Person failed to enroll into Medicare because they were incarcerated during an enrollment period.
- They must provide discharge documents or a record of release to SSA.
- SEP lasts 12 months from the date of release. Coverage can be retroactive up to 6 months prior to release, but those seeking retroactive coverage must pay Part B premiums for those months of retroactive coverage.
-
SEP to Coordinate with Termination of Medicaid Coverage:
- Person did not enroll in Medicare on time because they were covered under Medicaid, but Medicaid was later terminated OR
- Person lost their Medicaid because of being newly Medicare-eligible but then failed to enroll during their IEP.
- They must provide Medicaid termination notice or other record of termination to Social Security Administration.
- SEP lasts for 6 months from termination of Medicaid eligibility. Coverage can be retroactive up to 6 months back to date of termination.
-
Based on information provided by CMS staff, being put on Medicaid Spenddown will not count as “termination of Medicaid coverage,” but subsequently losing Medicaid coverage for failing to meet Spenddown will be considered termination. Avisery will be tracking closely how this new SEP is being implemented with Spenddown cases and will provide additional updates on this important topic.
-
SEP for Other Exceptional Conditions:
- Person must demonstrate that they missed their enrollment period for reasons beyond their control.
- Duration is determined on a case-by-case basis.
- Note that the “equitable relief” process still exists for individuals whose enrollment was delayed due to error by a federal employee.
For more information about these SEP’s or to start an application, contact Social Security Administration at (800) 772-1213.
Helpful Resources:
For the full text of the Final Rule click here.
As always, if you have any questions, please reply to Avisery@ageoptions.org.
| 
