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The current coronavirus (COVID-19) crisis has led to a number of changes in Medicare policy, including coverage for tests, treatments, nursing home stays, telehealth, and Medicare Advantage and Part D plan obligations.  Congress is currently working on passing a third bill related to the crisis, and is starting to plan for a fourth.

The Center for Medicare Advocacy has created a dedicated webpage to address these COVID-19 changes (including a summary of many of these policy changes here).  This webpage includes Center Alerts, CMS materials and other resources.

On March 26, 2020, the Center hosted a webinar with the California Senior Medicare Patrol (SMP) program that covered some of these changes, as well as highlighting some scams that have already emerged during this crisis, including a presentation from agents of the Department of Health & Human Services (DHHS) Office of the Inspector General (OIG).

In addition to issues impacting the coverage of individuals who already have Medicare, there are challenges for people who are transitioning to Medicare coverage, in part because the Social Security Administration (SSA) has closed its field offices. SSA services will still be available through the agency’s toll-free line, (800) 772-1213, and its website.  Below is general advice for people who are first becoming eligible for Medicare based on age or disability, as well as those who are losing employer-based health insurance coverage.

Enrolling in Medicare

Individuals who are first eligible for Medicare generally have a 7-month Initial Enrollment Period.  While local Social Security offices are closed to the public, some continue to provide services over the phone.  For individuals who need to apply for Medicare Parts A and B:

  • We suggest creating an account on www.ssa.gov
  • You can locate the telephone number to the local SSA office here: https://secure.ssa.gov/ICON/main.jsp
  • Note that SSA is extending deadlines for filing “whenever possible” – although the scope of such extensions are currently unclear

For those who are already eligible for Medicare and are retiring or otherwise losing their job and corresponding employer-based health insurance coverage based on current employment.

Some individuals will need to enroll in Medicare immediately due to growing job losses due to the coronavirus crisis.  As noted by journalist Mark Miller in a recent New York Times article entitled “Medicare Is Updating Coverage to Help in the Coronavirus Crisis” (3/24/20, updated 3/26/20)

People who work past age 65 can delay Medicare enrollment if they have health insurance through their employers without incurring steep penalties for late enrollment in Part B (10 percent lifetime for each 12-month period past the otherwise-mandatory sign-up age of 65).

If you were in this situation and need to sign up for Medicare now because of a job loss, you can take advantage of a special enrollment period that is available to you up to eight months after you lose coverage from employment.

In order to exercise a Part B Special Enrollment Period (SEP) right in this situation, certain documentation must be submitted to SSA, including:

  • CMS 40B Application for Enrollment in Medicare Part B (also see here) – assuming someone already has Part A of Medicare, AND
  • CMS L564 Request for Employment Information, which goes to the individual’s employer(s).

With many employers closing, or otherwise scaling back many functions, it will likely be difficult for individuals to obtain such forms from their employers.  Combined with the closure of SSA field offices, it will likely be difficult for individuals to submit such information to SSA to be processed.

As noted in Mr. Miller’s New York Times article cited above, our colleagues at the Medicare Rights Center recommend:

… starting the process by calling your local office to get the application started — you can find it using this local office directory. The field agent there can advise you on which forms, and any supporting documents, you will need to submit and where to mail them. Request a “protected filing date” and proof of receipt from the office. This will create a record that you applied for benefits on that date, which could affect the date your coverage begins.

As of the date of this Alert, it is unclear whether and how SSA is addressing these barriers during the current COVID-19 crisis.  Although our hope is that SSA will waive these requirements, at least temporarily, below we offer one potential “work around” to providing information from employers based on existing rules.

Tip – When Employer Information is Unavailable: SSA program rules – including those relating to eligibility, enrollment and premium payment for Medicare Parts A and B – are outlined in the Program Operations Manual System (POMS), available online.

One POMS provision deals with the required employer forms referenced above: HI 00805.295 Evidence of GHP or LGHP Coverage Based on Current Employment Status

In this POMS provision, there is a section outlining other documentation an individual can provide when an employer “cannot provide evidence.” (Note that “GHP” means employer Group Health Plans covering individuals over age 65 [specifically relating to employers that have at least 20 employees] and “LGHP” refers to Large Group Health Plans for individuals under 65 eligible for Medicare [specifically relating to employers with at least 100 employees]. Note that people who are under 65 having slightly different rules about employer size and partners with coverage, (not just spouses); we advise consultation with a SHIP counselor for individuals who are in this situation.)

Section B of this POMS provision states:

“B. Policy when the employer, GHP, or LGHP cannot provide evidence

When the employer, Group Health Plan (GHP) or Large Group Health Plan (LGHP)  cannot provide all evidence of GHP or LGHP coverage based on current employment status, the applicant may submit other documents that reflect employment, GHP or LGHP coverage (in addition to or in lieu of the evidence listed in HI 00805.295A of this section). Acceptable documents include but are not limited to:

      • income tax returns that show health insurance premiums paid;
      • W-2s reflecting pre-tax medical contributions;
      • pay stubs that reflect health insurance premium deductions;
      • health insurance cards with a policy effective date;
      • explanations of benefits paid by the GHP or LGHP; and
      • statements or receipts that reflect payment of health insurance premiums.”

So as long as SSA is requiring verification of employment, including employer documentation, individuals who have ready access to the documentation above can submit such documents and meet SSS requirements.

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