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Proposed Rule on Medicare Special Enrollment Periods (SEPs)

Proposed Rule on Medicare Special Enrollment Periods (SEPs)

On 22nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. This proposed rule would provide Medicare coverage the month immediately after enrollment, thereby reducing the uninsured period and expand access through Medicare special enrollment periods (SEPs). It would also allow eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty. This proposed rule would make it easier for people to enroll in Medicare and eliminate delays in coverage.

This is the first time that SEPs 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. These proposals implement important provisions of the Consolidated Appropriations Act, 2021 (CAA). Furthermore, these proposals support the Administration’s vision for CMS: to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding access to affordable coverage and care, and improving health outcomes.

An SEP is an opportunity for 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 SEPs to make changes to their Medicare coverage when certain events happen in their lives, such as moving or losing other insurance coverage. Rules about when people with Medicare can make changes to their coverage and the type of changes they can make are different for each SEP.

Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules. First, 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. Currently, if individuals enroll in Medicare in the last three months of their Initial Enrollment Period or in the General Enrollment Period, they may have to wait several months for Medicare coverage to begin. Second, the proposed rule also establishes a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant. If finalized, the proposed rule would promote accessibility to vital life-saving drugs. This rule, if finalized, would become effective January 1, 2023, and implement changes made by the CAA.

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