Medicare and the New Year: A Medicare Customer Question

What You Need to Know

The 2021 Consolidated Appropriations Act is starting to change things now.
Clients will have more ways to avoid the Part B late-enrollment penalty.
One new special enrollment period will involve evaluations done on a case-by-case basis.

The 2021 Consolidated Appropriations Act made sweeping changes in Medicare enrollment rules.

In October, the Centers for Medicare and Medicaid Services announced the regulations needed to implement the changes.

The changes will help some seniors get special enrollment periods for Medicare Part B coverage, even if they missed their initial enrollment periods. The SEPs could keep eligible clients from incurring Medicare Part B late fees.

The Question:

What are the new Medicare special enrollment period rules, and who do they apply to?

The Answer:

To understand the new special enrollment period rules, or SEP rules, you need to understand basic Medicare program terminology.

Medicare Part A is the Original Medicare program that covers the cost of inpatient hospital care.

Medicare Part B covers physician services and outpatient hospital care.

Stand-alone Medicare Part D prescription drug plans cover drugs, and Medicare Advantage plans typically include Part A, Part B and Part D coverage.

Most Medicare-eligible citizens use an initial enrollment period, or IEP, to sign up for full Medicare coverage, including Part B coverage. The IEP includes the three months before a client’s 65th birthday, the month of the client’s 65th birthday and the month after the client’s 65th birthday, or, for a client who continues to have employer-sponsored health coverage after age 65, the eight-month period after loss of employer or group plan coverage.

Clients who sign up for Medicare Part B coverage during the IEP can get the coverage without incurring any penalties.

Some late enrollees might qualify for a special enrollment period, or SEP.

Other clients who miss enrolling during the IEP period must wait to register until the next general enrollment period, or GEP, which occurs every year between January and March