Wanted to share this news from CMS about implementation of the new Special Enrollment Period for individuals leaving incarceration…

 

Brandy Bauer (she/her)

Director, Health Coverage & Benefits
571-527-3911
ncoa.org | @NCOAging

 

 

 

 

 

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I’m reaching out to inform you that the final rule which includes, among other provisions, the Special Enrollment Period (SEP) for individuals being released from incarceration, has been published. If you or your colleagues were able to provide comments, you may find them along with responses listed in the final rule here:  https://www.federalregister.gov/d/2022-23407/p-130

Below you’ll find a summary of the final SEP.  The proposed parameters of this SEP were as follows:

·        An individual would be eligible for this SEP if they demonstrate that they are eligible for Medicare and failed to enroll or reenroll in Medicare premium Part A or Part B during another enrollment period in which they were eligible to enroll while they were incarcerated. Further, there must be a record of release either through discharge documents or data available to SSA.

·        This SEP would start the day of the individual's release from incarceration and end the last day of the 6th month after the month in which the individual is released from incarceration.

·        Entitlement would begin the first day of the month after the month of enrollment, so long as it is after January 1, 2023.

We appreciate the support and feedback received from commenters on this SEP. Based on feedback from commenters, we will be finalizing this SEP as proposed with the following modifications:

·        We will be extending the SEP duration and revise §§ 406.27(d)(2) and 407.23(d)(2) to reflect that the SEP starts the day of the individual's release from incarceration and ends the last day of the 12th month after the individual is released from incarceration.

·        We are revising the text of the regulations at §§ 406.27(d) and 407.23(d) to use the phrase “in custody of penal authorities” as well as citing to § 411.4(b) in order to be clear that the scope of this new SEP is aligned with the scope of § 411.4(b). This change in terminology is intended to eliminate any unintended ambiguity that using different terms in these regulations could produce.

·        We are revising the entitlement date of this SEP at §§ 406.27(d)(3) and 407.23(d)(3) to provide that entitlement begins the first day of the month following the month of enrollment. Individuals also have the option of choosing an entitlement date retroactive to the first day of the month of their release from incarceration (not to exceed 6 months).

The links below to Medicare.gov are now live, and provide updated information based on the new SEP. 

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare

Thank you again for assisting with our outreach efforts.

Sincerely,

Barbara

 

 

Barbara McCoy, MSW

Associate Ombudsman

Offices of Hearing and Inquiries (OHI)

Centers for Medicare & Medicaid Services (CMS)

443-764-4536 (iPhone)