Phone System Delays Results in Medicare Enrollment Extension
Medicare Benefits Solutions
Jun 28, 2022
If you became newly eligible for Medicare in 2022, you might be one of the many frustrated applicants who had trouble with Medicare sign-up because of technical issues with the Social Security phone system. The fact that Social Security offices were closed to the public during the first quarter of 2022 made access even more difficult.
Medicare Enrollment Extension
In response to people worried about missed enrollment deadlines, the Centers for Medicare & Medicaid Services (CMS) devised a set of procedures to extend the amount of time allowed for Medicare enrollment. Equitable relief waives late penalties for people who could not enroll due to circumstances beyond their control.
Usually, the deadlines for Medicare enrollment and plan changes are rigid, with exceptions limited to clearly defined exceptional circumstances. Expect strict enrollment deadlines to return once the phone communication issues are resolved.
Medicare Equitable Relief: Special Enrollment Extension
Effective April 1, 2022, equitable relief addresses the problems with Social Security’s telephone system early in 2022. The Social Security Administration (SSA) encourages people to enroll online. However, people who do not have internet access or need help with the online application rely on talking to an SSA representative by phone or in person.
The relief measure also applies to beneficiaries with disenrollment requests. If you receive Social Security benefits, you automatically get Part A and Part B when you turn 65. If you are younger than 65, you are automatically enrolled after two years of receiving disability benefits. If an employer already covers you for healthcare, you may choose not to have Part B until the group coverage ends, in which case you would request a disenrollment.
The CMS explains the Limited Availability of Equitable Relief: “Given the recent technical issues, CMS is providing equitable relief to beneficiaries who could not submit premium-Part A or Part B enrollment or disenrollment requests timely. This relief applies to the 2022 General Enrollment Period (GEP), Initial Enrollment Period (IEP) and Special Enrollment Period (SEP).”
Medicare Enrollment Periods
Medicare enrollment begins with registration for Part A and Part B. Part A is hospital insurance to cover you upon admittance to a hospital, skilled nursing facility or religious non-medical facility. Coverage also includes hospice and home healthcare. Part B covers medical office visits, outpatient healthcare, mental health services, some home healthcare services, and durable medical equipment.
Most Medicare beneficiaries get Part A with no premium, referred to as premium-free Part A, but most people pay a premium for Part B. Medicare enrollment in Part B and premium-Part A is limited to these times:
- Initial Enrollment Period: seven-month window from three months before the month of your 65th birthday and ending three months later
- Special Enrollment Period: applicable if you have current employer-sponsored group health insurance
- General Enrollment Period: subject to late enrollment fees for beneficiaries who missed the initial and special enrollment periods
Late Enrollment Open Enrollment Penalty
The following are Original Medicare premiums and standard late penalty fees. If you are approved for equitable relief, you won’t have to pay a penalty for delayed registration.
Part A late enrollment penalty
If you paid Medicare taxes for at least 40 quarters (10 years) over your working lifetime, you are eligible for premium-free Part A. Less than 40 quarters will require the following monthly premiums in 2022:
- Less than 30 quarters: $499
- Between 30 and 39 quarters: $274
If the Part A late enrollment penalty is imposed, you could see a 10% bump in your premium for double the number of years you chose not to register for Part A. For example, if you opted not to enroll during the eligible two years, the additional premium would remain for four years.
Part B late enrollment penalty
The standard monthly premium for Part B starts at $170.10, and specific income ranges yield higher premium requirements. The late penalty is 10% for each year you are eligible and decide not to enroll in Part B.
Once you complete Medicare Part B enrollment, you can join a Medicare drug plan (Part D). The premium varies across insurers and locations. A Part D late fee applies if you did not sign up when you first became eligible and did not have other creditable drug coverage. This penalty, calculated using a specific formula, permanently increases your Part D premium.
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How Equitable Relief Works
You have until December 30, 2022, to apply for equitable relief if you are:
- Medicare-eligible between January 1 and December 30, 2022
- Unable to enroll due to SSA telephone issues
- Not yet enrolled
Once you can enroll, late penalties will be waived from the time you would have enrolled (had it not been for SSA phone issues) and the time you can sign up. Your coverage would begin the month following enrollment or the month coverage should have begun, depending on the enrollment period for which you are eligible. If your coverage is retroactive, you will be required to pay premiums for all the missed months.
Once you have Part A and Part B, you are eligible to apply for Medicare Advantage (MA). MA, or Part C, is an option for people who want to get their Medicare insurance from a plan that encompasses Part A, Part B and often additional benefits, such as Part D. If you tried but were unable to apply for an MA plan due to SSA phone issues, you may be eligible for a two-month Special Enrollment Period.
SSA final approval of your equitable relief is determined on a case-by-case basis, but CMS is encouraging field office employees “to be as responsive and flexible as possible” when the SSA’s problems have impacted a beneficiary.
To see if you qualify for Medicare equitable relief, visit the SSA website or contact your local Social Security office for more information.
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