“Health care isn’t just about fixing bones or handing out pills. It’s about giving people the peace of mind that comes with coverage when you need it,” said
This is the first time that SEPs will be available for people who were unable to register due to exceptional conditions. It is also the first time that lifesaving coverage for immunosuppressive drugs will be provided to people who would otherwise lose all Medicare coverage. Together, these proposals not only implement important provisions of the Consolidated Appropriations Act of 2021 (CAA), but also support
“CMS is committed to ensuring that people who are eligible for Medicare have timely access to this lifesaving coverage. This proposed rule, if finalized, will reduce the time it takes for people to receive Medicare coverage after enrollment and advance CMS’s strategic vision to expand access to affordable, quality health care and coverage,” said the CMS Administrator.
A SEP is an opportunity for people with Medicare to enroll in Part B if they did not enroll in Medicare during their initial enrollment period when they were first eligible. People with Medicare Advantage and Part D coverage can also use SEPs to make changes to their Medicare coverage when certain life events occur, such as moving or losing other insurance coverage. The rules about when people with Medicare can make changes to their coverage and what kind of changes they can make are different for each MS.
CAA Sections 120 and 402 made two key changes to Medicare enrollment rules. First, Medicare coverage will begin the month after enrollment for individuals enrolling during the last three months of their initial enrollment period or within the general enrollment period, reducing any potential gaps in coverage. . Currently, if people enroll in Medicare during the last three months of their initial enrollment period or the general enrollment period, they may have to wait several months before Medicare coverage begins. Second, the proposed rule also establishes a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain kidney transplant recipients. If finalized, the proposed rule will promote accessibility to life-saving medicines. This rule, if finalized, would come into effect
“These proposals underscore CMS’s efforts to advance health equity and improve access to Medicare,” said Dr.
Finally, CMS offers several technical updates to improve the administration of Medicare savings programs. These programs help make health insurance affordable for those struggling to pay for health care.
CMS encourages people approaching Medicare eligibility to research their Medicare coverage options and enrollment deadlines. Medicare.gov and 1-800-MEDICARE are both available to help people understand their choices and associated timelines. In addition, personalized health insurance counseling is available free of charge from State Health Insurance Assistance Programs (SHIPs). To visit shiptacenter.org or call 1-800-MEDICARE for the phone number for each SHIP.