CMS Proposes 5 Medicare Special Enrollment Periods

Medicare beneficiaries experiencing specific illnesses or circumstances could soon get Part B coverage outside the normal open enrollment periods under a proposed rule released Friday.

Individuals who are impacted by an emergency or disaster, formerly incarcerated people and those subject to a health plan or employer error that prevented them from enrolling in Medicare on time could get coverage during special enrollment periods under the Centers for Medicare and Medicaid Services proposal.

The agency additionally proposed extending the privileges to people who need to enroll after their Medicaid eligibility is terminated and others who are experiencing “exceptional conditions.” The latter would be decided on a case-by-case basis.

Medicare special enrollment periods for exceptional conditions have never been offered before, according to CMS. Congress gave the agency the authority to establish these special enrollment periods in 2021. Medicare Advantage beneficiaries can also use special enrollment periods to make changes to their coverage, though rules about when changes can be made differ with each enrollment period.

“These proposals highlight CMS’ efforts to advance health equity and improve access to Medicare,” Dr. Meena Seshamani, deputy administrator of CMS and director of the Center for Medicare, said in a statement. “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 proposed updating regulations governing state payments of Medicare Part A and B premiums for low-income individuals as well, including limiting states’ retroactive liability for paying Part B premiums to 36 months for dually-eligible beneficiaries.

The agency also wants to extend Medicare immunosuppressive drug coverage to kidney transplant patients who don’t have other health insurance coverage. Congress authorized the program last year.