CMS Recommends Special Enrollment Periods, Including Medicare Eligible Individuals Losing Medicaid Coverage

The Center for Medicare and Medicaid Services (CMS) is proposing new rules that includes new Special Enrollment Periods (SEPs) to provide individuals who meet certain exceptional conditions and who missed a Medicare enrollment period an opportunity to enroll without having to wait for the general enrollment period (GEP) and without being subject to a late enrollment penalty (LEP).

Specifically, CMS is proposing the following SEPs:

• An SEP for Individuals Impacted by an Emergency or Disaster that would allow CMS to provide relief to those beneficiaries who missed an enrollment opportunity because they were impacted by a disaster or other emergency as declared by a Federal, state, or local government entity.
• An SEP for Health Plan or Employer Error that would provide relief in instances where an individual can demonstrate that their employer or health plan materially misrepresented information related to enrolling in Medicare timely.
• An SEP for Formerly Incarcerated Individuals that would allow individuals to enroll following their release from correctional facilities.
• An SEP to Coordinate with Termination of Medicaid Coverage that would allow individuals to enroll after termination of Medicaid eligibility.
• An SEP for Other Exceptional Conditions that would, on a case-by-case basis, grant an enrollment period to an individual when circumstances beyond the individual’s control prevented them from enrolling during the IEP, GEP or other SEPs.

These proposals would expand Medicare enrollment opportunities and reduce multi-month coverage gaps in Medicare. To read more about it, check out this CMS Factsheet.