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This year, several long-anticipated changes to Medicare enrollment periods and prescription drug costs take effect.
General Enrollment Period (GEP)
The General Enrollment Period (GEP) runs from January 1 through March 31 of each year. Now, people who enroll in Medicare during the GEP will have their coverage begin the first of the month following the month they enroll, rather than having to wait until July 1.
Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) is the seven-month period surrounding an individual’s 65th birthday month. It includes three months before, the month of, and three months after someone’s 65th birthday month. Before 2023, people who enrolled in Medicare during the last three months of their IEP had to wait up to three months before their coverage would begin. Now, that gap in coverage is eliminated, and coverage is effective the first of the month after the month of enrollment for those who enroll in months four through seven of their IEP.
Special Enrollment Periods (SEPs) for Exceptional Circumstances
The Centers for Medicare & Medicaid Services (CMS) established new Special Enrollment Periods (SEPs) for Part B and premium Part A for those who experience an exceptional circumstance. These flexibilities expand Medicare enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties. New SEPs that beneficiaries who missed another enrollment period can use include:
SEP for Individuals Impacted by an Emergency or Disaster
This SEP is for people who missed an enrollment opportunity because they or someone who makes health care decisions on their behalf lives in an area where the federal, state, or local government declared an emergency.
SEP for Health Plan or Employer Misrepresentation or Incorrect Information
An individual can use this SEP if their employer, employer plan, or someone acting on behalf of their employer gave them incorrect information that caused them to delay Medicare enrollment.
SEP for Formerly Incarcerated Individuals
This SEP is for individuals who are released from incarceration1 on or after January 1, 2023. An individual has two options for when their coverage can begin:
SEP to Coordinate with Termination of Medicaid Coverage
This SEP, also called the Medicaid SEP, is for people who lose Medicaid eligibility on or after January 1, 2023, and do not have Medicare because they missed an enrollment opportunity.
There may be situations where someone lost Medicaid during the COVID-19 public health emergency, enrolled in Medicare before January 1, 2023, and has a late enrollment penalty. These individuals should contact Social Security to get the penalty removed. They should also be reimbursed for any penalties they have already paid.
An individual has two options for when their coverage can begin:
SEP for Other Exceptional Circumstances
Social Security can grant an SEP on a case-by-case basis. An individual can request to enroll through this SEP if they missed other enrollment periods because of things they could not control. Social Security decides if the individual’s situation is exceptional, meaning very unusual or not typical. Someone forgetting to enroll or not knowing that they were supposed to enroll does not count as exceptional circumstances.
Insulin Cost Sharing
Now, beneficiaries pay no more than $35 for each one-month supply of an insulin medication covered by their Medicare Part D plan. If the plan has a deductible, it does not apply to insulin medications.
Beginning July 1, 2023, Part B-covered insulin cost sharing is also capped at $35 per month.
Vaccine Cost Sharing
Now, there is $0 cost sharing and no deductibles for Part D-covered vaccines. This applies to vaccines, including the shingles vaccine, recommended by the Advisory Committee on Immunization Practices (ACIP) for adults.
Extended Part B Coverage of Immunosuppressants
Starting in 2023, there is a new, limited Medicare benefit called the immunosuppressive drug benefit, or the Part B-ID benefit. The Part B-ID benefit provides Part B coverage of immunosuppressant drugs for people whose End-Stage Renal Disease (ESRD) Medicare benefits have ended 36 months after their transplant and who do not have other health insurance that covers immunosuppressant medications.
Beneficiaries whose ESRD Medicare eligibility expired before January 1, 2023, can still enroll in Part B-ID. Those who qualify should contact Social Security to enroll.
Part B-ID has a monthly premium of $97.10 in 2023. Individuals enrolled in Part B-ID can apply for the Medicare Savings Program (MSP) for help with premium costs and, if eligible for the Qualified Medicare Beneficiary MSP, cost-sharing assistance.
Part B-ID coverage may not be the best choice if someone has or has access to any other insurance. This is because Part B-ID only covers immunosuppressant drugs; it does not include coverage for any other benefits or services and does not allow a person to access Part A.
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