CMS aims to eliminate delays in new Medicare coverage, expand special enrollment periods

The Biden administration wants to close the gap before new Medicare beneficiaries can get coverage and expand use of special enrollment periods. 

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Friday that updated Medicare enrollment and eligibility rules. One of the key proposals is to provide Medicare coverage a month immediately after enrollment, reducing the uninsured period for the beneficiary. 

“Healthcare is not just about mending bones or dispensing pills. It’s about giving people peace of mind that comes with having coverage when you need it,” said Department of Health and Human Services Secretary Xavier Becerra in a statement. 

Currently, if someone enrolls in Medicare in the last three months of their initial enrollment period or general enrollment period, it could take several months for coverage to take effect. If the proposal is finalized, Medicare coverage would start a month afterward.

The rule also would extend for the first time special enrollment periods (SEPs) to those who can’t enroll due to “exceptional conditions.” 

The period will enable Medicare beneficiaries to enroll in Part B if they did not enroll during their initial enrollment period when first eligible, CMS said in a statement. 

“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 their insurance coverage,” CMS said in a release on the proposal. “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.”

CMS is also proposing a new immunosuppressive drug program that would extend the coverage of such products to beneficiaries that had a kidney transplant.

“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,” said Meena Seshamani, M.D., Ph.D., director of the Center for Medicare and CMS’ deputy administrator.

If finalized, the proposals will implement provisions passed under the Consolidated Appropriations Act of 2021.