As a result of the Consolidated Appropriations Act, 2021, new Medicare enrollment rules will allow coverage to start sooner for many beneficiaries in 2023 and expand Special Enrollment Periods and Part B drug coverage eligibility!
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Let’s explore how these changes may affect your clients and your business.
In general, your clients enrolling in Medicare should experience fewer coverage gaps in 2023 and beyond. Effective dates will be more streamlined for beneficiaries, with most coverage beginning one month after enrollment. Additionally, more Special Enrollment Periods (SEPs) will be available. Those with disability access to Medicare coverage will also have access to extended Part B drug coverage to maintain treatment of their immunosuppressant health conditions.
Effective dates will be more streamlined for beneficiaries, with most coverage beginning one month after enrollment.
New IEP & GEP Effective Dates for Beneficiaries
Currently, a client’s effective date of coverage varies depending on when they enrolled in Medicare coverage during their Initial Enrollment Period (IEP) or if they enrolled during the General Enrollment Period (GEP). This will change in 2023.
These are the current enrollment guidelines:
- Enrolls during any of the first three months of their IEP: Coverage starts when they turn 65
- Enrolls during their IEP in the month they become eligible: Coverage starts the month after they sign up
- Enrolls during any of the last three months of their IEP: Coverage starts two to three months after they sign up
- Starting January 1, 2023, Medicare coverage will begin one month after enrollment for clients who enroll in the last three months of their IEP
- Enrolls during the GEP, from January 1 through March 31: Coverage starts July 1
- Starting January 1, 2023, Medicare coverage will begin one month after enrollment for clients who enroll during the GEP.
New Medicare SEPs
To anticipate the circumstances of enrollees with exceptional conditions, CMS is implementing the following new SEPs for beneficiaries enrolling in Medicare Parts A and B:
- An SEP for Individuals Impacted by an Emergency or Disaster that would allow CMS to provide relief to those beneficiaries who missed an enrollment opportunity because they were impacted by a disaster or other emergency as declared by a federal, state, or local government entity.
- An SEP for Health Plan or Employer Error that would provide relief in instances where an individual can demonstrate that their employer or health plan materially misrepresented information related to enrolling in Medicare timely.
- An SEP for Formerly Incarcerated Individuals that would allow individuals to enroll following their release from correctional facilities.
- An SEP to Coordinate with Termination of Medicaid Coverage that would allow individuals to enroll after termination of Medicaid eligibility.
- An SEP for Other Exceptional Conditions that would, on a case-by-case basis, grant an enrollment period to an individual when circumstances beyond the individual’s control prevented them from enrolling during the IEP, GEP or other SEPs.
Individuals who qualify for these SEPs will no longer have to wait for GEP to enroll in coverage, therefore eliminating coverage gaps for many.
Additional Coverage of Immunosuppressant Drugs
Individuals with End-Stage Renal Disease (ESRD), at any age, are eligible for Medicare. Currently, coverage for immunosuppressant drugs continues for 36 months after a kidney transplant but expires after those 36 months , unless the client is eligible for Medicare based on age or additional qualifications.
According to the new rules, individuals on immunosuppressants can enroll in Part B coverage after those 36 months starting in October 2022, with coverage beginning in January 2023. This is intended for access to immunosuppressant drugs that are necessary to maintain a client’s treatment. CMS calls this benefit the “Part B-ID benefit.”
Additional details regarding this benefit include:
- No specific enrollment periods
- Only covers immunosuppressive drugs — not any other Part B benefits or services
- Individual cannot be enrolled in or expect to be able to enroll in certain other types of coverage (e.g., group health plan, TRICARE, or a Medicaid state plan that covers immunosuppressive drugs)
- If signing up for other coverage, individual must provide notification to the Social Security Administration within 60 days
- Premium will be less than the standard Part B premium
- Enrollees not subject to late enrollment penalties
- Individuals eligible for certain Medicare Savings Programs can receive coverage of the immunosuppressive drug benefit premium, and for Qualified Medicare Beneficiaries, cost sharing as well
What This Means for Your Business
Even though a few changes have occurred, this shouldn’t cause you or your clients concern. These changes have been made to add benefits for clients and make it easier for them to access Medicare coverage! As you begin to navigate these changes, our best suggestion is to notify your clients and make sure they are as well-informed as you are. Make sure your T65 clients are aware of when their IEP begins and when their coverage will start. If your client is a member of a group plan, marketplace plan, or other health coverage, make sure that their coverage ends before their Medicare coverage begins.
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These changes allow you to streamline the enrollment process and advocate for your clients. Continue to check out our blog to read the most recent updates from CMS!
Ritter is dedicated to staying on top of the most recent Medicare updates to make sure that you can be the best agent you can be for your clients. Register with our site to stay informed!