Confusion over Medicare Enrollment Extension Amidst COVID-19

By Dave Rich, CEO, Ensurem

Medicare enrollment can be tricky even during normal times. Throw a global pandemic into the mix, and it doesn’t get any easier. As such, the Centers for Medicare and Medicaid Services (CMS) announced a Special Enrollment Period (SEP) that extends the enrollment period for Medicare health and drug plans for some beneficiaries. But to many consumers’ confusion, it doesn’t extend enrollment for Original Medicare Parts A & B.

How has COVID-19 affected Medicare enrollment?

The outbreak and rapid spread of COVID-19 has made normal Medicare enrollment significantly more difficult in some areas of the country.

The Social Security Administration (SSA), the government agency which handles enrollment in Medicare, closed offices all over the country and has moved its operations to online and over-the-phone. Many private insurance companies have followed suit. These changes make it difficult for those who previously preferred or relied on face-to-face services for health care plan management to adjust to changing procedures. In addition, massive job losses flooded the market with seniors looking to enroll into Medicare plans after losing their group coverage.

Because of these difficulties, CMS granted a nationwide SEP for Medicare health and prescription drug plans.

What seniors need to know about COVID-19 SEPs

Medicare Advantage and Prescription Drug Plan (PDP) SEPs typically extend enrollment time for beneficiaries affected by “exceptional” conditions such as FEMA declared weather-related emergencies or major disasters. CMS announced on May 5 that it was granting a four-month SEP for beneficiaries who were eligible for, but unable to make an election because they were affected by the ongoing public health crisis.

This mean that anyone who had a valid election period during the incident is granted extra time to enroll in or unenroll from Medicare Advantage and PDP. According to CMS SEP guidelines, the COVID-19 incident period begins on the date of the President’s initial emergency declaration on March 1 and ends on June 30.

This SEP is available to beneficiaries nationwide as long as they meet the following criteria:
• Had another valid election period at the time of the incident period; and
• Did not make an election during that other valid election period.

What about enrolling into Medicare Parts A & B?

Many consumers will confuse SEP provisions with Original Medicare enrollment extensions, but they are in fact different. While this SEP extends election periods for Medicare Advantage health and prescription drugs plans, it does not do the same for Original Medicare Parts A & B.

People who were unable to enroll in Original Medicare during the normal enrollment periods due to the COVID-19 pandemic-related national emergency were granted what’s called “equitable relief.” This offered beneficiaries extra time to enroll in Medicare Parts A & B. However, this assistance was only available between March 17 and June 17.

Enrollment eligibility and product selection confusion can be barriers to entry

SEPs and equitable relief grants aside, enrollment into Medicare-related products continues to be a difficult and confusing time for many people. There are many plans to select from, and each plan is different—whether it is in-network doctor selections, hospitals, pharmacies, co-pays, etc. For many people, trying to lay all these options on the table and select the best can be a daunting task accompanied by financial pressure. According to a 2019 study, roughly 530,000 bankruptcies filed annually are due to debt accrued from medical illnesses.

Some of the most common questions seniors have about Medicare revolve around what product selection is right for them and when and how they should enroll in those products. Without accurate answers to these questions, beneficiaries can end up under insured with coverage that doesn’t meet their needs.

Enrollment eligibility differs between each of the four Parts of Medicare (A-D), as well as for Medicare Supplement insurance. But, what remains the same for each, is that it’s usually always best to enroll into plans during your initial enrollment periods (IEP). If you don’t enroll during IEPs, depending on the type of coverage, you could be limited to enrolling during select annual enrollment periods, or may face increased premiums or ineligibility.

For example:
• If you delay enrollment into Medicare Part B, you will be charged a 10% increase in monthly premiums for every 12 months you go without coverage.
• If you decide a Medicare Advantage plan might be right for you, but miss enrollment during your Medicare IEP, you may have to wait until the Medicare annual election period (AEP).
• If you decide Medicare Supplement insurance is right for you, but miss enrollment during your Medigap IEP, you may be subjected to medical underwriting during enrollment which leaves you at risk for increased premiums or denial of your application.

With such particular enrollment regulations, seniors are obligated to make coverage selections within certain time frames. If you make a selection that doesn’t quite fit your needs, you’re oftentimes stuck with your choices for at least a year, if not more.

A quick run-down on enrollment periods

Below is a list of each of the enrollment periods that apply to Original Medicare Parts A & B, Medicare Advantage Part C, Part D prescription drugs plans (PDP) and Medicare Supplement (Medigap) plans. Understanding these enrollment periods can help ensure Medicare beneficiaries receive the right coverage at the right time.

• 7-month Medicare Initial Enrollment Period (IEP)
• 6-month Medigap Initial Enrollment Period (IEP)
• October 15 – December 7 Medicare Annual Enrollment/Election Period (AEP)
• January 1 – March 31 Medicare Advantage Open Enrollment Period (OEP)
• January 1 – March 31 Medicare General Enrollment Period (GEP)
• Medicare Special Enrollment Period (SEPs)
• Medicare Advantage & PDP SEPs

The most effective ways to get Medicare information

One of the most effective ways for seniors to receive the information they need to make educated choices regarding their healthcare coverage after retirement is to start the conversation online and continue it with a licensed agent over the phone. CMS offers several online resources with detailed and up-to-date information on their website, medicare.gov as do most insurance companies and brokers.

We recommend using a broker over going to an insurance company direct, because brokers will usually work with multiple insurance carriers, offering a wider selection of products. If you need guidance choosing a plan selection that works for your health needs and personal budget, it’s especially helpful to work with a licensed agent who is versed in and can sell a wide variety of plans.

Understanding enrollment periods and the regulations surrounding them is oftentimes the most complicated aspect of Medicare, and confusion surrounding this topic can lead to seniors being under insured. It’s important for beneficiaries to understand and take advantage of their rights.. Licensed agents can help you understand your enrollment eligibilities and rights to ensure you receive the right coverage exactly when you need it.

Dave Rich, CEO of Ensurem (an online, multi-carrier insurance brokerage and technology company in the retail Medicare solutions market with a large and swift capacity to reach over ¼ million seniors per month trying to navigate Medicare coverage options) has held various positions over his 40-year career in the insurance industry. Experienced in both the home office environment and independent distribution companies, Dave has a unique understanding of agent and consumer preferences and the needs for insurance profitability and risk management. For the 10 years preceding the founding of Ensurem in 2016, he held the positions of Chief Operating Officer and Chief Marketing Officer of AmeriLife Group LLC, one of the largest insurance marketing companies in the country. He also spent over two decades in executive positions within multiple national insurance carriers, including Great American Financial Resources, Manhattan National Life Insurance Company and Life Partners Group.

Category: Blog