Pursuant to federal regulations that took effect on January 1, 2023, individuals who lose Medicaid coverage will be granted a special enrollment right to enroll in Medicare Part B coverage.[1] This special enrollment right was created in part because the COVID health emergency order may soon end, resulting in many people losing Medicaid coverage. In this regard, under federal law enacted in response to COVID, the federal government gave states increased Medicaid funding and, in exchange, states were required to provide continuous Medicaid enrollment during the COVID emergency even if individuals became ineligible after initial enrollment.[2] When the COVID health emergency order ends, State Medicaid programs will return to normal, which in most states means they will require individuals to demonstrate Medicaid eligibility periodically, with many people losing coverage when that redetermination occurs. With these new federal regulations, people who lose Medicaid coverage will be treated the same as people who lose employer health benefits, who have been granted special enrollment rights to enroll in Medicare Part B for many years.
In addition, some states extend this special enrollment right to Medicare Supplement (“MedSupp”) insurance, allowing people who lose Medicaid coverage to also purchase a MedSupp policy. While some states allow for continuous or annual enrollment in MedSupp policies and other states already provide a special enrollment right when Medicaid benefits end, most states do not. This is however changing and Ohio is an example. In this regard, the Ohio Department of Insurance recently released a proposal to change the Ohio MedSupp regulation to extend special enrollment rights to people who have lost Medicaid coverage.[3] Other states are also considering similar changes to their state MedSupp rules to allow for similar enrollment rights. This will give people additional options to obtain health insurance benefits when their Medicaid ends, which may be the case for many people soon when federal COVID health emergency order ends.
If you would like more information on these developments, please do not hesitate to contact the authors.
[1] See 42 C.F.R. 406.27(e). Medicare Part A covers hospital services. Medicare Part B covers doctors visits, outpatient services and certain other services.
[3] Proposed Amendment to Ohio Admin. Code 3901-8-08, available at: https://insurance.ohio.gov/static/Legal/Rules/Documents/3901%240-8-08-Rule-AM.pdf