The final rule updates Medicare enrollment and eligibility rules to expand coverage for people with Medicare and advance health equity.
The Centers for Medicare & Medicaid Services (CMS) on Friday issued a final rule that makes it easier for people to enroll in Medicare and eliminates delays in coverage. The rule will be published in the Federal Register on November 3.
The final rule implements changes made by the Consolidated Appropriations Act, 2021 (CAA), which allows individuals to obtain Medicare coverage the month immediately after their enrollment, expands access through Medicare special enrollment periods (SEPs), and allows certain eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty. The rule takes effect January 1, 2023.
“The Biden-Harris Administration has made it clear: we are committed to doing all we can to strengthen Medicare,” said HHS Secretary Xavier Becerra in an announcement. “Today, we’re making it easier to enroll, expanding access, and eliminating delays in coverage to improve Medicare for the millions of Americans who depend on it. We’re working tirelessly to deliver the health insurance and peace of mind that enrollees deserve.”
The final rule makes special enrollment periods available for individuals who previously were unable to enroll due to exceptional conditions. It’s also the first time that vital coverage for immunosuppressive drugs will be provided for individuals who have had a kidney transplant and otherwise would lose all Medicare coverage. “Each part of this critical rule advances CMS’ strategic vision of expanding access to quality, affordable health coverage and care,” said CMS Administrator Chiquita Brooks-LaSure in the announcement.
The SEP will allow individuals to make changes to their health coverage outside of a typical enrollment period. The SEPs finalized in the rule will allow 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 the new SEPs include eligible individuals who miss an enrollment opportunity because:
- They were impacted 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
- Their Medicaid coverage was terminated after the COVID-19 public health emergency ends or on or after January 1, 2023 (whichever is earlier)
“These changes highlight CMS’ efforts to advance health equity and improve access to Medicare,” said Dr. Meena Seshamani, deputy administrator of CMS and director of the Center for Medicare. “Reducing gaps in coverage, allowing for special enrollment periods for individuals in exceptional circumstances, spending money in a smarter way on kidney transplant patients – these are meaningful changes that put people at the center of their care and improve the Medicare program.”
CMS also made several technical updates to improve the administration of the Medicare Savings Programs. For more, check out the CMS fact sheet.