CMS Proposes SEP for New Beneficiaries, Closing Coverage Gaps

Last Friday, April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to rectify a few of the issues many Americans face with Medicare enrollment.

The CMS press release says the proposed rule will implement provisions from the Consolidated Appropriations Act of 2021 and President Joe Biden’s executive orders. As always with the Biden administration, the rules are part of the broader effort to promote equity in American healthcare and to support CMS as “a trusted partner and steward” for Medicare beneficiaries.

Currently, Americans nearing the Medicare qualification age of 65 have seven months to enroll, but if they fail to enroll within that set period they are required to pay higher Part B premiums for the entire time they receive Medicare benefits.

Americans may avoid these higher premiums by enrolling within a seven-month window: three months before the beneficiary’s birth month, the beneficiary’s birthday month, and the three months following. But many are unable to enroll during this time through no fault of their own. According to AARP, the proposed rule establishes special enrollment periods to assist those who could not sign up during the initial enrollment period.

Modern Healthcare notes that CMS also proposed updating regulations governing state payments of Medicare Part A and B premiums for low-income beneficiaries, including limiting states’ retroactive liability for paying Part B premiums. The rule also includes an extension of immunosuppressive drug coverage to kidney transplant patients without other health insurance coverage.

From CMS’s Center for Medicare director Meena Seshamani, MD, PhD:

Reducing gaps in coverage, allowing for special enrollment periods for individuals in exceptional circumstances, spending money more smartly on kidney transplant patients — these are meaningful changes that put people at the center of their care and improve the Medicare program.