CMS finalizes Medicare enrollment and coverage changes

The Centers for Medicare & Medicaid Services Friday finalized a rule updating Medicare enrollment and eligibility rules to strengthen coverage and ease enrollment, as required by the Consolidated Appropriations Act of 2021. AHA expressed support for the updates in an April letter to the agency. 

Effective immediately under the rule, individuals with end stage renal disease who do not have other health insurance can enroll in Medicare Part B coverage for immunosuppressive drugs beyond the 36-month post-transplant period. 

Effective Jan. 1, coverage for individuals enrolling in traditional Medicare during the last three months of their initial enrollment period or during the general enrollment period will begin one month after enrollment. The rule also creates special enrollment periods for people impacted by an emergency or disaster; who were formerly incarcerated or had their Medicaid eligibility terminated; or whose employer or health plan materially misrepresented information related to timely enrolling, among other exceptional conditions.

In addition, the rule requires states to specify their policy for paying Medicare Part A and B premiums on behalf of low-income individuals in their Medicaid plan; and limits states’ liability for retroactive Part B premiums to 36 months for certain full-benefit dually eligible beneficiaries, among other changes.