On April 22, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed implementation of parts of the Consolidated Appropriations Act, 2021 (CAA) to simplify Medicare enrollment. According to Medicare.gov, these changes will go into effect January 1, 2023. Generally speaking, the new Medicare enrollment rules will allow for a more straightforward enrollment process that reduces potential gaps in coverage. They also allow for more Special Enrollment Periods and extend some Part B coverage to certain beneficiaries. But, what are the specifics?
All facts and figures can be found in CMS’ fact sheet on the provisions, unless specifically linked elsewhere.
Current Medicare Enrollment Rules
Currently, when Medicare coverage actually starts after enrollment can be pretty confusing. When your coverage becomes effective can depends on when you enrolled during your Initial Enrollment Period (IEP), the roughly seven-month window generally starting three months before your 65th birthday and running three months after. (There is an exception if your birthday is on the first of a month. Your birthday month is considered the month before your true birthday month.)
Right now, the Medicare enrollment rules look like this:
- Enroll before your birthday month during your IEP Coverage starts during your birthday month
- Enroll during your birthday month during your IEP Coverage starts the month after you sign up
- Enroll after your birthday month during your IEP Coverage starts two to three months after you sign up
- Enroll during the General Enrollment Period (GEP) from January 1 to March 31 Coverage starts July 1, up to six months after you sign up
The last two rules meant that many Medicare beneficiaries had gaps in their coverage as they waited months for coverage to kick in.
Medicare Enrollment Rules for 2023 & Beyond
CMS’ recent changes modify the effective dates of Medicare coverage for someone enrolling in the last three months of their IEP (after their birthday month) or during the GEP, getting rid of the long waiting periods by mandating that their Medicare coverage must be effective the month after enrollment.
Here’s what the new Medicare enrollment rules for the IEP and GEP look like:
- Enroll before your birthday month during your IEP Coverage starts during your birthday month
- Enroll during your birthday month during your IEP Coverage starts the month after you sign up
- Enroll after your birthday month during your IEP Coverage starts the month after you sign up
- Enroll during the General Enrollment Period (GEP) from January 1 to March 31 Coverage starts the month after you sign up
There are even many more changes Please click here for the rest of the bulletin