The proposed rule aims to expand Medicare coverage and establishes five special enrollment periods.

The Centers for Medicare & Medicaid Services (CMS) on Friday released a proposed rule that would expand access to Medicare through special enrollment periods and provide Medicare coverage the month immediately after enrollment to reduce the uninsured period.  It also would allow eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty.

The proposed rule, CMS said in an announcement, would make it easier for people to enroll in Medicare and eliminate delays in coverage.

“Health care is not just about mending bones or dispensing pills. It’s about giving people peace of mind that comes with having coverage when you need it,” said U.S. Health and Human Services Secretary Xavier Becerra. “That’s why we’re proposing this rule today to help reduce delays, eliminate gaps, and expand access to care for people with Medicare.”

If finalized, it will be the first time that special enrollment periods will be available for individuals who 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 otherwise would be losing all Medicare coverage.

The proposals would implement provisions of the Consolidated Appropriations Act, 2021 (CAA) 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 by eliminating confusing coverage waiting periods and allowing CMS and the Social Security Administration to remedy missed enrollment periods by permitting special enrollment periods for exceptional conditions.

The special enrollment periods would allow people with Medicare to enroll in Part B if they didn’t enroll in Medicare during their Initial Enrollment Period when they were first eligible. People with coverage under Medicare Advantage and Part D can also use these periods to make changes to their Medicare coverage when certain events happen in their lives, such as moving or losing other insurance coverage.

Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules:

  • Medicare coverage will become effective the month after enrollment for individuals enrolling in the last three months of their initial enrollment period or in the General Enrollment Period, thereby reducing any potential gaps in coverage.
  • The proposed rule establishes a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant. If finalized, it would promote accessibility to vital life-saving drugs.

The proposed rule creates five special enrollment periods:

  • A special enrollment period for individuals impacted by an emergency or disaster that allows CMS to provide relief to 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.
  • A special enrollment period for health plan or employer error in instances when individuals can demonstrate their employers or health plans materially misrepresented information related to enrolling in Medicare in a timely manner.
  • A special enrollment period for formerly incarcerated individuals that would allow them to enroll following their release from prisons.
  • A special enrollment period to coordinate with termination of Medicaid coverage that would allow individuals to enroll after termination of Medicaid eligibility.
  • A special enrollment period for other exceptional conditions that would, on a case-by-case basis, grant an enrollment period to individuals when circumstances beyond their control prevented them from enrolling during the initial enrollment period, general enrollment period, or other special enrollment periods.

If finalized, the rule would take effect Jan. 1, 2023.

For more information, click here for the proposed rule, here for the CMS announcement, and here for a fact sheet.