Identification Number:
HI 00805 TN 46
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Supplementary Medical Insurance Entitlement
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 05 – Supplementary Medical Insurance Entitlement
Transmittal No. 46, 05/09/2022

Audience

PSC: BET, BTE, CR, CST, CTE, DEC, EHI, LCC, PAS, PCS, PETL, RECONR;
OCO-OEIO: BET, BIES, CCRE, CR, CTE, EIE, ERE, FCR, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

Updating section to improve the tone and readability of the policy.

Summary of Changes

HI 00805.025 General Enrollment Period (GEP)

Update section 3 with SMI and GEP enrollment language

 

HI 00805.025 General Enrollment Period (GEP)

A. Definition of GEP

A GEP is the first calendar quarter of each year (January through March).

B. Policy

1. GEP enrollment

The person who fails to enroll during his IEP, or refuses automatic enrollment, may enroll only during the GEP.

The person whose SMI has ended because of non-payment of premiums or voluntary withdrawal from SMI, may reenroll only during the GEP.

EXCEPTION: For a person who becomes eligible for SMI and does not lose that eligibility, the only time enrollment after the IEP need not occur in a GEP is where the individual meets the requirements for an SEP, as described in HI 00805.265ff.

2. Extension of GEP

When the GEP ends on a day which is a non-workday (e.g., Saturday, Sunday, legal holiday, etc.), an eligible individual may enroll on the first regular workday after the end of the GEP.

3. When SMI will begin

SMI entitlement based on a GEP enrollment will begin the first of the month after the month of enrollment.

Prior to January 1, 2023, SMI entitlement based on a GEP enrollment always begins July 1 of the year during which the GEP enrollment took place..

4. Inquiry late in GEP

Individuals who inquire by telephone about enrollment shortly before a GEP expires should be told to make their request for SMI enrollment on a letter or postcard and immediately mail it to the FO, if they are unable to visit the FO before the end of the GEP.


HI 00805 TN 46 - Supplementary Medical Insurance Entitlement - 5/10/2022