AAFP Notches Win With Medicare Eligibility, Enrollment Rule

The AAFP pushed for adoption of the rule when it was proposed earlier this year, telling CMS in a June 24 letter that it would reduce coverage delays, allow continuous access to comprehensive care and simplify enrollment for patients.

The rule, “Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules,” became final Oct. 28. It shortens the gap between Medicare enrollment and the commencement of coverage for many beneficiaries, and it increases the number and scope of Medicare special enrollment periods, including after public health emergencies such as COVID-19.

The Academy voiced strong support for the SEPs outlined in the proposed rule, all of which remain in the final version. Specifically, the rule adds or lengthens SEPs for individuals affected by

• a federally, state- or locally declared emergency or disaster;
• misrepresented or incorrect information from a health plan or employer; and
• prior incarceration (in line with longstanding AAFP advocacy).

In a further victory, the length of an SEP that follows an emergency or disaster declaration will now be six months rather than two months.

The Academy also backed a provision in the rule that will allow coverage for newly eligible individuals to begin on the first day of the month after the month in which they enroll. The finalized change shortens what some new Medicare beneficiaries had experienced as a three-month coverage delay.