People who become eligible for Medicare during the pandemic may have decided not to enroll, thinking they did not need it because they were covered by Medical Assistance. Now they may be outside a Medicare enrollment period. However, many will be eligible for a Medicare Special Enrollment Period (SEP) based on the termination of their Medical Assistance due to the PHE. This SEP will allow them to enroll in Medicare and have coverage begin either the next month or retroactive to the month Medical Assistance coverage ends.

Special Enrollment Period for Termination of Medical Assistance eligibility
Requirement: Lost Medical Assistance coverage on or after 1/1/23

Some people with both Medicare and Medical Assistance may lose Medical Assistance coverage and will no longer be eligible for their Medicare Advantage Plan (also called Dual Eligible Special Needs Plans, MSHO or D-SNPs). They will lose their care coordination benefit.

Beneficiaries in these types of situations will need special counseling, including information on Medicare enrollment periods, penalties, Medicare supplement and Medicare Advantage plan options.

• People in this scenario have a 3-month SEP to change to a PDP or advantage plan. 
  • These people also have on-going Extra Help so would have a second SEP under that. 
• They also may have a guaranteed issue rights (GIR) for 63 days into a Medigap policy per state statute. 
  • Because of the vague wording in the statute, you may find a Medigap policy denies GIR. If this happens, please file a complaint directly with the Minnesota Department of Commerce. 
    • Call: 651-539-1600 or 1-800-657-3602 (8 AM - 4:30 PM)
    • Or submit the complaint on their online portal. Select the insurance complaints at the top left. 

Special Enrollment Period for Termination of Medical Assistance eligibility
Requirement: Lost Medical Assistance coverage on or after 1/1/23

During the 3-year PHE, the Medical Assistance enrollee became eligible and enrolled in Medicare Part A and B but did not make any Medicare plan enrollment decisions. They paid their monthly Medicare Part B premiums.

• Because they enrolled in Medicare Part B during the PHE, their 6-month Medicare supplement guaranteed initial rights (GIR) without underwriting has passed.  There is no SEP to purchase a Medicare supplement policy.
• They are also beyond their 7-month Medicare Open Enrollment Period.
• ​​​​They should, however, be eligible for the SEP due to loss of their Medical Assistance coverage and an additional SEP due to Extra Help. 

Options include: 

• Join a Medicare Advantage Plan or Medicare Prescription Drug Plan.
• Switch from their current plan to another Medicare Advantage Plan or Medicare Prescription Drug Plan.
• Drop their Medicare Advantage Plan and return to Original Medicare.
• Drop their Medicare prescription drug coverage.
• Their chance to change lasts for 3 full months from either the date they're no longer eligible or notified, whichever is later.