New Rule Reduces Medicare Coverage Gaps

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.

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.