New Rule Reduces Medicare Coverage Gaps
Starting in 2023, enrollees wouldn’t have to wait as long for benefits to kick in
A new federal regulation will keep 65-year-olds from having to wait for their Medicare coverage to kick in regardless of when they apply during official enrollment periods. The rule, finalized on October 28, also provides several new special enrollment windows, including for people who, through no fault of their own, didn’t sign up when they were supposed to.
The new regulation implements Medicare enrollment changes included in the sweeping appropriations law Congress passed in late 2020 and will take effect Jan. 1.
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Under Medicare’s current rules, Americans turning 65 have a seven-month window to enroll. If they wait longer, they have to pay higher Part B premiums for as long as they get Medicare benefits. Part B covers doctor visits and other outpatient services.
Here’s how it works now: The seven-month initial enrollment period includes the three months before your 65th birthday, your 65th birthday month and the three months following your 65th birthday month. If you sign up before your 65th birthday, your coverage takes effect the month you turn 65 and become eligible for Medicare. If you enroll the month you turn 65, your benefits start the next month. But if you sign up during any of the last three months of your initial enrollment period, you have to wait two or three months for your coverage to kick in.
People who don’t sign up during their initial enrollment period get another shot at enrolling during Medicare’s general enrollment period (GEP), which runs from Jan. 1 to March 31 each year. But there’s a catch. Currently, if you sign up during this GEP, you have to wait until July 1 for your coverage to become effective.
New rule closes the gaps
This new rule changes that. Starting next year, as long as you apply for Medicare during any part of your seven-month initial enrollment period or during the general enrollment period, your coverage would take effect the beginning of the following month. So if, for example, you apply on May 15, 2023, your coverage would start June 1, 2023. The Centers for Medicare and Medicaid Services estimates that more than 100,000 people would benefit from the general enrollment period change each year.
AARP has been fighting for such changes for years. “Along with other stakeholders, AARP has worked to educate members of Congress about how older Americans are falling through the cracks or were being unfairly penalized even though they were following the rules to sign up,” says Andrew Scholnick, AARP senior legislative representative for government affairs, health care access and affordability. AARP is also continuing to fight for legislation that would alert older Americans every year beginning at age 60 that they will become eligible for Medicare at age 65.
The appropriations law also allows Medicare to establish special enrollment periods (SEPs) that will help people whose unusual circumstances prevented them from signing up during their initial enrollment period. Examples of these SEPs include:
- Allowing someone to enroll late who missed their initial period because they were affected by a natural disaster or other government-declared emergency.
- Allowing someone to enroll who can show that their employer gave them bad information that led them not to sign up when they were supposed to.
- Providing a special period for formerly incarcerated individuals to enroll after they are released from prison.
- Allowing someone to enroll whenever they no longer qualify for Medicaid, the federal-state health insurance program for low-income persons. This will be especially important when the federal government lifts the COVID-19 public health emergency.
- On a case-by-case basis, allowing people to enroll when circumstances beyond their control prevent them from enrolling during a government-prescribed period.
Editor's Note: This story, originally published April 26, 2022, has been updated to reflect new information.