2023 has brought some positive changes to Medicare, including the $0 out-of-pocket costs for Part D covered vaccines, $35 monthly cap on Part D-covered insulin products (see Medicare’s new fact sheet), and the option of continued Medicare coverage for immunosuppressive drugs for eligible beneficiaries with a kidney transplant. In addition, 2023 brings several improvements/changes in Medicare’s enrollment periods and an expansion of Special Enrollment Periods (SEPs).
Medicare’s Initial Enrollment Period, also called the IEP, is the seven-month period including the three months before, the month of, and the three months following your 65th birthday month. In the past, if you enrolled later in your IEP, you would have to wait longer for your Medicare to start. Yet as of 2023, your Medicare will start the month after you enroll, but no earlier than the first of your 65th birthday month. This is great news, as this change gets rid of or shortens the gap in coverage for those who enroll later during their IEP. It is also much simpler to figure out when exactly your Medicare coverage will begin. Below is an image from the SMP National Resource Center’s January Medicare Minute publication demonstrating when coverage begins.
The General Enrollment Period, also called the GEP, runs from January 1 through March 31 of each year. In the past, if you enrolled during the GEP, your Medicare would not start until July. Yet as of 2023, when you use the GEP your Medicare will begin the first of the month after you enroll. For example, if you enrolled on January 1 in past years, you would have to wait until July 1 for your Medicare to start. With these changes, if you enroll using the GEP in January, for example, your coverage will instead start on February 1.
Special Enrollment Periods, also called SEPs, are periods of time outside normal enrollment periods when you can enroll in Medicare or change your coverage. SEPs are sometimes triggered by specific life circumstances. Beginning in 2023, new SEPs have been created for people who:
- Lose Medicaid (Medi-Cal in California) on or after January 1, 2023 – The SEP begins when receiving notice of upcoming termination of Medi-Cal eligibility and ends six months after termination of Medi-Cal eligibility. Coverage begins either the first of the month following enrollment, or can be retroactive to the date of Medi-Cal termination, no earlier than 1/1/23.
- Are in an area with a disaster or emergency that has impacted your ability to enroll in Medicare – The SEP begins the date of the local, state or Federal emergency or disaster is declared, as long as it is after January 1, 2023. The SEP ends six months after the emergency date declaration. If an emergency declaration is extended, the SEP ends six months after date of extension. Coverage begins the first of the month following enrollment.
- Are released from incarceration on or after January 1, 2023 – The SEP begins the day the individual is released from jail and ends the last day of the 12th month after the individual is released. Coverage begins either the first of the month following enrollment, or up to six months retroactively (but not before January 1, 2023).
- Make an enrollment mistake based on misinformation from your employer, your employer group health plan, or someone acting on behalf of your employer. You can only use this SEP if you received misinformation on our after January 1, 2023. The SEP begins the day you notify Social Security of the misinformation, and ends six months after. Coverage begins the first of the month following enrollment. For this SEP, you will need to provide documentation that shows you were misinformed. Examples include:
- Letter or other document from the employer that has incorrect information in it
- Letter from the employer that acknowledges that they gave out misinformation
- Written statement from you that describes the misinformation if you do not have written proof from your employer or your employer’s representative
- Experience other exceptional circumstances – Social Security will grant these SEPs on a case by case basis. Start and end dates for the SEP depend on the circumstances.
These additional SEPs will expand enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties. Contact your local Health Insurance Counseling and Advocacy Program (HICAP) to see if you are eligible for an SEP.