Final Medicare rule aims to reduce gaps in coverage
The rule creates special enrollment periods and improves the administration of the Medicare Savings Programs.
Photo: Roberto Westbrook/Getty Images
A new final rule updates Medicare enrollment and eligibility rules as eligible individuals wade through their options during the open enrollment period.
The rule, released Friday by the Centers for Medicare and Medicaid Services, gives individuals access to Medicare coverage the month immediately after enrollment, expands special enrollment periods, and allows certain eligible beneficiaries to receive Part B coverage without a late enrollment penalty.
CMS is encouraging people who are approaching Medicare eligibility to research their coverage options and enrollment deadlines at Medicare.gov and 1-800-MEDICARE. Personalized health insurance counseling is available at no cost from State Health Insurance Assistance Programs.
Medicare Open Enrollment runs from October 15 to December 7, 2022.
The changes finalized in this rule go into effect January 1, 2023.
CMS said it is also making several technical updates to improve the administration of the Medicare Savings Programs.
WHY THIS MATTERS
The final rule makes it easier for people to enroll in Medicare and eliminates delays in coverage, CMS said.
The special enrollment period (SEP) provides an opportunity for eligible individuals to enroll in Part B if they didn't enroll in Medicare during their initial enrollment period when they were first eligible, and to do so without a late enrollment penalty.
Examples of new SEPs created by this rule are for eligible individuals who miss an enrollment opportunity because they were affected by a disaster or government-declared emergency; their employer or health plan materially misrepresented information related to timely enrollment in Medicare Part B; they were incarcerated; or their Medicaid coverage was terminated after the COVID-19 Public Health Emergency, or PHE, ends or on or after January 1, 2023 (whichever is earlier).
The final rule also establishes a new immunosuppressive drug benefit that extends coverage to certain individuals who have had a kidney transplant and otherwise would lose Medicare coverage.
THE LARGER TREND
These changes implement provisions of the Consolidated Appropriations Act, 2021 and support President Biden's executive orders on Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government and Continuing to Strengthen Americans' Access to Affordable, Quality Health Coverage.
They aim to eliminate confusing coverage waiting periods and allow CMS and the Social Security Administration to remedy missed enrollment periods by permitting eligible individuals to enroll in Medicare Part B through SEPs for exceptional conditions.
ON THE RECORD
"CMS is committed to ensuring that people eligible for Medicare have timely access to this vital coverage," said CMS Administrator Chiquita Brooks-LaSure. "For the first time, special enrollment periods will be available in traditional Medicare for individuals who were unable to enroll due to exceptional conditions, and individuals who have had a kidney transplant will now be able to receive extended Medicare coverage for immunosuppressive drugs. Each part of this critical rule advances CMS' strategic vision of expanding access to quality, affordable health coverage and care."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
