COVID-19 Updates to Medicare Enrollment and Emerging Social Security Office Efficiencies to Process Changes for Beneficiaries

1. Social Security - Availability and Advice for Contacting Offices

National Public Radio recently reported that the backlog of cases pending in Social Security Administration (SSA) offices has fallen by 11% since March 23, when the agency instituted wide-scale telework, and that calls from Social Security recipients are being answered more quickly.[1]

While SSA offices are closed to the public, the Center for Medicare Advocacy (Center) has found the local/regional field offices to be more responsive than usual by telephone. We have been told by SSA offices that since walk-in appointments are cancelled, the staff has more time to respond by phone, if not immediately, usually in the same day. This is true even for issues that have required multiple follow-ups, with multiple people on the line (SSA claimant or Medicare beneficiary in one place, advocate in another, family member in another) - SSA has arranged for those multiple-way calls.

An individual can locate the local SSA office by zip code https://www.ssa.gov/locator/. Then find the phone number for the local office. Callers should leave a message if they get a recording and the call will be returned. Some SSA offices are only responding to messages so they can screen which staff member should return the call.

Still, persistence is likely needed since more people are/will be looking for assistance getting on Social Security and Medicare. As for applications, we recommend that individuals do as much online as possible, then if there are questions, SSA can retrieve the online application attempt by the individual and walk through the areas of the application where people have questions.

2. COVID-19-Related Updates to Medicare Parts A and B Enrollment[2]

CMS is granting equitable relief in the form of additional time to use an Initial Enrollment Period (IEP), General Enrollment Period (GEP), or a Special Enrollment Period (SEP) (such as the SEP for when a beneficiary’s enrollment in employer coverage based on current employment ends) in order to file an application for Part B, premium-Part A, or to refuse automatic Part B.

In addition, eligible beneficiaries would not be subject to a late enrollment penalty for the period between the original enrollment period and the enrollment during this extension of the enrollment period.  Beneficiaries are eligible for equitable relief due to the COVID-19 pandemic-related national emergency if they were unable to make their Part A or Part B enrollment choice in a timely manner due to delays and problems with access to the SSA to file an application or enrollment election, as a result of the unexpected closure of field offices due to COVID-19.

• The beneficiary had an enrollment period during the period from March 17, 2020, through June 17, 2020, that was an IEP, GEP, SEP; and
• The beneficiary did not apply for Part B (or premium-Part A) or refuse Part B during that IEP, GEP, or SEP.

Individuals who already have Medicare Part A and wish to sign up for Medicare Part B cannot sign up online. Individuals interested in using the relief to enroll in Medicare Part B coverage who are eligible to apply under the IEP or GEP should complete form CMS-40B and mail the request to their local SSA field office.

Individuals who are receiving Social Security benefits before their 65th birthday are considered to be in their IEP and are automatically enrolled in Part A and Part B.  Those who do not want to be automatically enrolled in Part B must refuse the coverage within 60 days of receiving their IEP package. Instructions on how to refuse the coverage are included in the IEP package. Individuals may also contact the Social Security Administration at 1‑800-772-1213 (TTY users should call 1-800-325-0778) for more information on how to refuse the coverage.

Individuals interested in enrolling in Medicare Part B coverage who are eligible to apply under the SEP, should complete forms CMS-40B and CMS-L564 (PDF); both forms are available in English and Spanish versions. The CMS-40B application is completed entirely by the individual enrolling in Part B.

For the CMS-L564 enrollment form:

• Section A:
• Must be completed by individuals enrolling in Part B
• Section B:
• Can be completed by the employer; OR
• If it isn’t feasible for your employer to complete the form, leave Section B (the rest of the form) blank and provide at least one of the items listed below.  Acceptable proof of employment, Group Health Coverage Plan (GHP), or Large Group Health Plan (LGHP) 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 receipt that reflect payment of health insurance premiums

Individuals can fax their completed enrollment forms to SSA toll-free at 1-833-914-2016, or mail the request to their local SSA field office.  Although SSA offices are closed for in-person service, requests received by mail are still being processed. Individuals can find the address and phone number for their local field office using the Social Security Office Locator https://secure.ssa.gov/ICON/main.jsp.

This assistance is available retroactive to March 17, 2020, and will continue for a period of 3 months ending June 17, 2020.  Beneficiaries need to have qualified for and missed an enrollment opportunity during this period.  Eligible beneficiaries must submit their delayed enrollment request before June 17, 2020.

CMS has created a page for additional questions and answers.[3]

3. COVID-19 Related Updates to Medicare Parts D and C Enrollment[4]

A Special Enrollment Period (SEP) is available nationwide to residents of all states, tribes, territories, and the District of Columbia effective March 1, 2020.
A beneficiary is affected and eligible for a SEP if he or she:

• Had another valid election period at the time of the incident period; and
• Did not make an election during that other valid election period.

The SEP is available for four full calendar months (through June 30, 2020).  Further, an eligible beneficiary would be given one opportunity to make that missed election as a result of this SEP.  Beneficiaries will not be expected to provide proof that they were affected by the pandemic-related emergency.

Beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week with any questions. TTY users should call 1-877-486-2048. They can submit their enrollment request through 1-800-MEDICARE, their agent/broker, or by contacting the Medicare health or prescription drug plan directly.

Beneficiary-directed questions and answers for this SEP are available at any of the following links on CMS.gov and address issues such as eligibility for the SEP and how to enroll:

• Questions and Answers on the Medicare Managed Care Eligibility and Enrollment webpage: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/Disaster_SEP_QAs_for_Beneficiaries.pdf
• Questions and Answers on the Medicare Prescription Drug Eligibility and Enrollment webpage: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol/index

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[1] https://www.npr.org/2020/05/05/850106772/for-these-federal-employees-telework-means-productivity-is-up-
their-backlog-is-d
[2] https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol/index
[3] https://www.cms.gov/files/document/enrollment-issues-covid-ab-faqs.pdf
[4] https://www.cms.gov/files/document/special-enrollment-period-sep-individuals-affected-fema-declared-weather-related-or-other-major.pdf