This emergency message (EM) provides instructions for
handling Medicare Part B (Supplementary Medical Insurance) enrollment
requests from beneficiaries with Medicare Part A (Hospital Insurance)
who also are or were enrolled in an individual Marketplace plan. It also
contains instructions for Part B premium surcharge rollback for certain
beneficiaries with both Medicare Part A and Part B who have or had
Marketplace coverage.
Coverage under Medicare Part A meets the legal
requirement for minimum essential coverage. Individuals with Medicare
Part A are not eligible to receive premium and cost-sharing assistance
(often referred to as advanced payments of the premium tax credit (APTC)
or income-based cost sharing reductions (CSRs)) to help pay for a
Marketplace plan premium and covered services to make the costs of a
Marketplace plan more affordable. Individuals receiving APTC while
dually-enrolled in coverage through the a Marketplace and Medicare may
have to pay back all or some of the APTC received for months an
individual was enrolled in both Marketplace coverage with APTC and
Medicare Part A when they file their federal income tax return.
Some people may have had coverage through the
Marketplace (and possibly received APTC or CSRs) before being eligible
for Medicare. When first eligible for premium-free Medicare Part A,
these individuals may have refused or dropped Medicare Part B coverage
because the costs for Marketplace coverage, with any financial
assistance they may have been receiving, was more affordable than
Medicare Part B, and they believed they were eligible for APTC and CSRs.
In addition, some people with Medicare Part A
coverage may have enrolled in coverage through the Marketplace believing
it was an alternative way to get medical coverage equivalent to
Medicare Part B at a more affordable cost. These individuals may not
have found out they were not eligible for APTCs or CSRs or not learned
about the coverage rules prior to the end of their Medicare Initial
Enrollment Period (IEP), resulting in them either 1) declining to enroll
in Medicare Part B at all; or 2) enrolling in Medicare Part B during
the General Enrollment Period (GEP) and being assessed a Medicare Part B
late enrollment penalty.
CMS [Centers for Medicare and Medicaid Services] believes that many of these individuals did not
receive the information necessary at the time of their Medicare IEP or
initial enrollment in coverage through the Marketplace to make an
informed decision regarding their Medicare Part B enrollment. ...
Equitable relief will be considered on a case-by-case
basis for certain dually-enrolled beneficiaries (those who have or had
both Medicare and Marketplace coverage) of any age who refused or
dropped Part B and for those who subsequently enrolled in Part B during
the 2015, 2016 or 2017 GEP.
Beneficiaries who refused or dropped Part B may
receive equitable relief in the form of an enrollment opportunity with
an effective date outlined in Section E of this instruction. The ability
to provide the enrollment opportunity under equitable relief is limited
to Part B enrollment requests received from September 1, 2016 through
September 30, 2017. No late enrollment penalty will be applied for
individuals who enroll in Part B under this limited equitable relief. ...
By the way, I had clients who asked about declining Part B for this reason and I told them not to do it. I can't think of a reason to decline Part B other than getting all of one's healthcare from the VA (and being happy with it) or living outside the U.S.
Also, by the way, I can just imagine a Trump transition team member trying to review this Emergency Message and being completely befuddled by it. As President Trump said, "nobody knew healthcare could be so complicated."
