For reprint by GWAAR Legal Services Team
The Centers for Medicare & Medicaid Services (CMS) simplified Medicare enrollment and coverage start dates beginning January 1, 2023. These rules changed Medicare coverage start dates for people who enroll in Premium Part A or Part B during the last three months of their Initial Enrollment Periods (IEPs) or through the annual General Enrollment Period (GEP) which runs from January 1st through March 31st. The rules also created new Special Enrollment Periods (SEPs) for people enrolling into Medicare outside of their IEPs or the GEP.
- People who become eligible for Medicare on or after January 1, 2023 and who enroll during the last three months of their IEP will be enrolled in Premium Part A and/or Medicare Part B the month after enrollment. Premium-free Part A coverage will still be backdated to the first day of the month they turn 65 for people enrolling during their IEP.
- People who enroll during the first three months of their IEP will still have coverage begin the first day of the month they turn 65.
- Remember that people with the first-of-the-month birthdays start their IEPs earlier, and they become eligible for Medicare the first day of the month before they turn 65.
- People who enroll during the GEP will have Premium Part A and/or Part B coverage start the month after enrollment. If they are enrolling in Premium-free Part A for this first time during the GEP, their Part A coverage will backdate up to six months.
In addition, the new CMS rules finalized the following new SEPs for enrollment into Medicare Part A or Part B without a late enrollment penalty.
- Individuals impacted by an emergency or disaster: for beneficiaries who missed an enrollment opportunity because they were affected by a disaster or other emergency declared by a Federal, state, or local government agency. This SEP will last for six months after the end of the emergency declaration. The SEP may also be used if the disaster or emergency takes place where the individual’s authorized representative, legal guardian, or person who makes health care decisions on their behalf lives.
- Health plan or employer error: for individuals who can show that their employer or health plan materially misrepresented information related to enrolling in Medicare on time. The SEP also includes brokers and agents of health plans as sources of misinformation. This SEP will last for six months after the individual tells SSA, and it allows the individual to write a statement describing what happened if documentation of misinformation from the employer or health plan is not available.
- Formerly incarcerated individuals: will allow them to enroll following their release from correctional facilities. This SEP will last for 12 months after they are released and allow them to choose between up to six months of retroactive coverage back to their release date or coverage beginning the month after the month of enrollment. An individual who selects retroactive coverage must pay the premiums for the retroactive covered time period.
- Coordinate with termination of Medicaid coverage: will allow individuals who have missed a Medicare enrollment period to enroll in Medicare after their Medicaid coverage ends. The SEP lasts for six months after the last date of Medicaid coverage. Individuals may choose between retroactive coverage back to their last date of Medicaid coverage (but no earlier than January 1, 2023) or coverage beginning the month after the month of enrollment. If an individual selects retroactive coverage, they must pay the premiums for the retroactive covered time period. In addition, individuals who would have been eligible for this SEP but who enrolled during the COVID-19 Public Health Emergency before January 1, 2023 are eligible to have any late enrollment penalties refunded and removed.
- Other exceptional conditions: will, on a case-by-case basis, allow for an enrollment period for individuals when circumstances beyond their control prevented them from enrolling during the IEP, GEP, or other SEPs. This SEP will last for a minimum of six months.
