TN 19 (03-93)

HI 00805.700 Outmoded Rules on Enrollment Periods and Coverage

A. BACKGROUND - THE “INITIAL GENERAL ENROLLMENT PERIOD”

Where the first month of SMI eligibility occurred before 3/1/66, the initial opportunity to enroll in SMI began 9/1/65 and ended 5/31/66. This was called “the initial general enrollment period” (IGEP) since all the aged were first able to enroll at that time. (Enactment of the Medicare law occurred on 7/30/65.) For those individuals who enrolled for SMI during the IGEP, SMI coverage began 7/1/66.

B. BACKGROUND - “GOOD CAUSE” ENROLLMENTS

If an individual who was eligible prior to 3/66 did not enroll during the IGEP but showed “good cause” for failure to enroll before 6/1/66, he/ she was permitted to enroll from 6/1/66 through 9/30/66. In these “good cause” cases, SMI began with the sixth month after the month of enrollment.

C. BACKGROUND - THE GEP PRIOR TO 1969

There was originally a GEP of 3 months (October through December) in every second year beginning with 1967.

The first GEP began 10/1/67 and should have ended 12/31/67, but the Congress extended it through 3/31/68 (actually, 4/1/68, since 3/31/ 68 was a Sunday). Thus, this GEP lasted 6 months. After 1968, the GEP occurred each January through March, except as noted in 3. below.

D. BACKGROUND - OPEN ENROLLMENT/TWO-ENROLLMENT LIMITATION

Section 945 of P.L. 96-499, with an effective date of 4/1/81:

  • Replaced the January - March GEP with a continuous open enrollment period (OEP) beginning immediately following the close of the individual's IEP (enrollment could take place in any month with coverage effective 3 months later); and

  • Deleted all reference to the two-enrollment limitation (which had barred an individual from enrolling in SMI more than twice).

These changes allowed a person to enroll for SMI or Premium-HI at any time after the IEP, with no limit on the number of times he/she could re-enroll. The OEP was repealed effective 9/30/81 by section 2151 of P.L. 97-35 and the January - March GEP reinstated. The two-enrollment limitation was not reinstated. Thus, enrollment may occur in SMI and Premium-HI an unlimited number of times.

E. BACKGROUND - EFFECT OF OEP/TWO- ENROLLMENT LIMIT ON PREMIUM PENALTY

An individual's SMI premium must be increased by 10 percent for each full 12-month period during which he/she could have been but was not enrolled. During the 4/81 - 9/30/81 OEP, the months counted for penalty (surcharge) purposes ran through the month the enrollment request was filed (or deemed to have been filed).

Since it was unreasonable to impose a penalty for failing to enroll during a time when the law prevented enrollment, no months in a period during which the individual was barred from re-enrolling by the two-enrollment limitation were counted towards the premium penalty.

F. BACKGROUND - SMI ENROLLMENT DURING IGEP FOR PREMIUM-HI

Premium-HI became effective 7/1/73 for uninsured persons age 65 or over. Among the requirements for Premium-HI is that the individual have SMI or be eligible for SMI and file a timely enrollment request. Many people who wanted Premium-HI had terminated two prior periods of SMI when there was still a two- enrollment limitation. They would have been unable to enroll in Premium-HI if they could not enroll in SMI.

Accordingly, during the Premium-HI IGEP (12/1/72 - 8/31/73), an eligible individual could enroll once for SMI and Premium-HI even though he/ she had already had two periods of SMI coverage.


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http://policy.ssa.gov/poms.nsf/lnx/0600805700
HI 00805.700 - Outmoded Rules on Enrollment Periods and Coverage - 03/17/1993
Batch run: 01/27/2009
Rev:03/17/1993