1. What are the Medicare Open Enrollment Dates?
Medicare Open Enrollment dates explained:
- Medicare Advantage Open Enrollment starts January 1st and ends March 31st. Medicare Advantage, which plan sponsors under Medicare Part C, is an alternative to traditional Medicare Part A (inpatient), Medicare Part B (outpatient), and Medicare Part D (prescription drugs and durable medical equipment).
- Traditional Medicare Open Enrollment starts on October 15th and ends on December 7th.
2. Are There New Provisions that Help Certain Medicare Insureds?
Yes. To explain,
- Medicare has new provisions to speed up the time from application to coverage for all insureds.
- For those with special life events such as disasters or other emergencies, there are new special enrollment opportunities outside of the traditional set open enrollment dates.
- For kidney transplant patients, coverage is improved for life-saving immunosuppressive drugs.
3. What Caused a Change in the Medicare Open Enrollment Period for 2023?
In short, the federal government is asking for more data from prescription drugs, air ambulance providers, and improved access to healthcare claim data and costs to insured healthcare consumers.
The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) final rule on October 28, 2022, to implement several changes in Medicare enrollment and eligibility. These changes were part of the Consolidated Appropriations Act of 2021 (CAA). See also Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, (CCA) 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules.
The Consolidated Appropriations Act of 2021 (CAA) primarily focused on implementing increased consumer protections related to surprise billing and transparency in health care, including the No Surprises Act. The No Surprises Act hinged on two principles:
(a) Qualifying Payment Amount (QPA) and associated calculations, and
The CAA also has a transparency initiative with three pillars. In other words:
Prescription Drug Data Collection (RxDC)
To explain, the Prescription Drug Data Collection provision is required under section 204 of Title II (Transparency) of the CAA. The law requires insurance companies and employer-based health plans to submit information about prescription drugs and healthcare spending to the U.S. Department of Health & Human Services (HHS), Labor, and Treasury.
Gag Clause Prohibition Compliance Attestation (GCPCA)
To elaborate, the GCPCA is required under section 201 of Title II (Transparency) of the CAA. It requires certain health plans to submit an attestation of compliance to HHS, Labor, and Treasury annually.
GCPCA requires an attestation of compliance with:
1. Internal Revenue Code (Code) section 9824,
2. Employee Retirement Income Security Act (ERISA) section 724,
3. Public Health Service (PHS) Act section 2799A-9, as added by section 201 of Title II (Transparency) of the CAA.
In other words, all three of the above provisions reiterate these two points that the CCA encourages:
(1) providing provider cost or quality of care information through a consumer engagement tool or other means to referring providers, the plan sponsor, participants, beneficiaries, or enrollees, or individuals eligible to become participants, beneficiaries, or enrollees of the plan or coverage;
(2) Improving electronic access to de-identified claims (on a per-claim basis if requested) for insureds when they make a compliant request (e.g., HIPAA, Genetic Information Nondiscrimination Act of 2008 (GINA), and Americans with Disabilities Act of 1990 (ADA))
Specific Focus on High-Cost Air Ambulance Data Collection (AADC)
AADC data collection is required under section 106 of the No Surprises Act. Above all the law requires air ambulance providers, insurance companies, and employer-based health plans to submit information about air ambulance services provided to consumers.
2. What was the intent of the change promulgated by the CAA?
Consequently, these changes are designed to minimize gaps in coverage for people who sign up for Medicare and improve access to care by :
a. reducing the time gap between Medicare enrollment and coverage;
b. creating new Special Enrollment Periods for individuals who would otherwise have delayed coverage due to challenging circumstances, such as natural disasters; extending coverage of immunosuppressive drugs for certain beneficiaries with end-stage renal disease (ESRD) who would have lost coverage for these drugs after their kidney transplant.
4. What are the key changes in Medicare Enrollment and eligibility?
To elaborate, there are changes to open enrollment to improve access as mentioned above. In other words there are new provisions such as:
b. Changes to the general enrollment period so that they are covered on the first day of the month after signing up instead of waiting until July 1st of the enrolment year
c. Five special enrollment periods for individuals with specific life events:
a. Emergency or disaster
b. Health plan or employer error
c. Formerly incarcerated
d. Loss of Medicaid coverage
e. Some other exceptions
d. Medicare Part B adds immunosuppressive Drug Benefits. Those insureds with kidney transplants are eligible to receive a benefit called Part B-ID.
Finally, I recommend that people spend an hour or two to shop plans every year. Medicare Part C provides for a combination of Medicare Advantage plans (separate enrollment from January to March) that can protect you from out-of-pocket costs, whether related to hospital, doctor’s office, or drug costs.
Indeed, I recommend that Medicare insureds consider Medicare Gap plans, which can be compared on federal agency websites such as this one: https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
There are complex provisions regarding amounts that Medicare insureds may have to pay out of pocket and any monthly premium. Medicare Gap plans can help protect you against additional costs in these areas:
a) Skilled nursing facility care coinsurance
b) Part A deductible
c) Part B deductible
d) Part B excess charge
e) Foreign travel exchange (up to plan limits)