Effective Dates: 03/21/2024 - Present Previous | Next

TN 104 (03-24)

HI 00805.346 Special Enrollment Period (SEP) for Eligible Postal Annuitants and Eligible Family Members to Enroll in Medicare Part B

CITATIONS:

Public Law 117-108; Section1862(b)(1)(E) of the Social Security Act (42 U.S.C. 1395y(b)(1)(E))

 

A. Background

The Postal Service Reform Act of 2022 (H.R. 3076) was signed into law on April 6, 2022. The law requires certain Medicare eligible United States Postal Service (USPS) annuitants[1] (and their family members) who are entitled to benefits under premium-free Medicare Part A to enroll in Medicare Part B in order to enroll in a Postal Service Health Benefits (PSHB) Program plan, effective January 1, 2025. The following are the exceptions to this requirement:

  • •

    A Postal Service annuitant who, as of January 1, 2025, has no entitlement to premium-free Medicare Part A and is not enrolled in Medicare Part B.

  • •

    A Postal Service employee who is, as of January 1, 2025, at least 64 years old.

  • •

    The individual is residing outside the U.S. and its territories.

  • •

    The individual is enrolled in health care benefits provided by the Department of Veterans Affairs.

  • •

    The individual is eligible for health services from the Indian Health Service.

The legislation requires the Office of Personnel Management (OPM) to identify individuals who are eligible to enroll in Part B and notify them of their eligibility to enroll in this Special Enrollment Period. The notice will also serve to identify and inform SSA of individuals eligible to enroll.

B. One-time Medicare Part B Special Enrollment Period

The Postal Service Reform Act of 2022 establishes a one-time Medicare Part B Special Enrollment Period (SEP) for eligible Postal Service annuitants (e.g. certain retirees) and their eligible family members. The one-time SEP will run from April 1, 2024 through September 30, 2024.

NOTE: 

For SSA purposes, the one-time SEP will be referred to as the USPS SEP, PSRA SEP or PSHB SEP.

C. Eligibility for the SEP

Eligible individuals are those who are entitled to benefits under premium-free Medicare Part A but are not enrolled in Medicare Part B and wish to enroll or remain enrolled in their PSHB Program.

NOTE: 

Individuals who are only eligible to enroll in premium HI for the aged or premium HI for the working disabled are not eligible for this SEP.

1. Eligible Postal Service Annuitants

An individual is eligible for the SEP if:

  • –

    As of January 1, 2024, they are a Postal Service annuitant who is entitled to benefits under premium-free Medicare Part A, and

  • –

    is not currently enrolled in Medicare Part B.

2. Eligible Family Members of Postal Service Annuitants

An individual is eligible for the SEP if:

  • –

    As of January 1, 2024, is a member of family[2] of a Postal Service annuitant and is entitled to benefits under premium-free Medicare Part A, and

  • –

    is not currently enrolled in Medicare Part B.

NOTE: 

Individuals may use this SEP to reenroll in Part B. While an individual is not eligible to enroll in this SEP if they are currently enrolled in Part B, they may be eligible for this SEP if they have been enrolled in Part B in the past, even after 1/1/24.

Example: A USPS employee retired in December 2023. The employee was 67 years old and a USPS annuitant as of January 1, 2024. The individual became entitled to benefits under premium-free Medicare Part A when they turned 65 in 2021. The individual qualifies for the USPS SEP since they meet the qualifications and are not currently enrolled in Medicare Part B. The individual can enroll in Medicare Part B during the six-month SEP (April 1, 2024 through September 30, 2024) and their Medicare Part B coverage will begin January 1, 2025.

D. Medicare Part B coverage effective date

The individual’s Medicare Part B coverage will begin on January 1, 2025, regardless of when they enrolled during the six-month SEP.

E. Calculation of premium surcharge

Eligible Postal Service annuitants (e.g. certain retirees and their eligible family members) who enroll in Medicare Part B via the one-time SEP may be subject to Part B late enrollment penalties (LEP). The USPS will pay these penalties directly to the Centers for Medicare & Medicaid Services.

F. Examples of individuals with retroactive HI effective dates

  1. a. 

    Example: Suzanne Jackson is retired from the USPS and receives an annuity from OPM. Suzanne attained age 65 in June 2022, but never enrolled in Medicare or filed a Retirement Insurance Benefit (RIB) claim until December 21, 2023 when Suzanne files for both RIB and premium-free Medicare Part A. Suzanne declined to enroll in Medicare Part B. Suzanne is fully insured and the claim is allowed. However, Suzanne’s claim is not updated to the Master Beneficiary Record (MBR) until February 16, 2024. Once the claim updates on February 16, 2024, the MBR will reflect a HI-START of June 2023 (6 months retroactive to the SMI-FILING of December 2023), and a SMI refusal. Suzanne would then be eligible for the USPS SEP for the remainder of April through September 2024

  2. b. 

    Example: Mike Higgins is retired from the USPS and receives an annuity from OPM. Mike attained age 65 in June 2022, but never enrolled in Medicare or filed a RIB claim until April 22, 2024 when Mike files for both RIB and premium-free Medicare Part A. Mike is fully insured, and Mike’s claim is allowed. The MBR reflects a HI-START of October 2023 (6 months retroactive to the SMI-FILING of April 2024), and a SMI refusal. Mike would then be eligible for the USPS SEP for the remainder of April through September 2024.

  3. c. 

    Example: Lisa Richards is retired from the USPS and receives an annuity from OPM. Lisa attained age 65 in June 2022, but never enrolled in Medicare or filed a RIB claim until August 21, 2024 when Lisa files for both RIB and premium-free Medicare Part A. Lisa is fully insured, and the claim is allowed. The premium-free HI START date is effective February 2024 (6 months retroactivity). In this scenario, since Lisa is not eligible for premium-free HI until February 2024 and has no premium-free HI coverage in January 2024, Lisa is NOT eligible for the USPS SEP. Instead, SSA’s Enrollment (EN) software on an initial claim would give Lisa Part B coverage in February 2025, with a SMI-PERIOD = ‘A’ (assumed enrollment period – deemed to have filed in the 2025 GEP during January), and Lisa may incur a late enrollment penalty if Lisa files for Part B.

G. Group Health Plan (GHP) SEP and PSRA SEP

Eligible Postal Service annuitants may also simultaneously be eligible for a GHP SEP to enroll in Medicare. If this is the case, technicians should educate individuals on their choice. Should they choose to enroll using the GHP, their coverage effective date depends on the month of enrollment (see POMS HI 00805.276). They may or may not have a premium surcharge. Should they enroll in the PSRA SEP, their coverage will begin January 1, 2025, and any applicable surcharge will be paid by the USPS. USPS will pay these penalties directly to the Centers for Medicare & Medicaid Services and therefore, front end development is not required by technicians for premium surcharge rollback (see HI 00805.280).

H. Processing instructions

USPS sends an SEP enrollment package to all eligible United States Postal Service annuitants and their family members starting on March 15, 2024 to inform them of the one-time Special Enrollment Period that will run April 1, 2024 through September 30, 2024. The enrollment package will include the following items:

  • •

    A notice with instructions on how to apply for the USPS SEP; and

  • •

    A return envelope addressed to the following address:

    Social Security Administration

    Wilkes-Barre Direct Operations Center

    PO Box 67650

    Wilkes-Barre PA 18767-7650

    NOTE: 

    The return envelope will have an indicator on the envelope “USPS PSHB PSRA”.

  • •

    A pre-filled CMS-40B form (Application for Enrollment in Medicare Part B (Medical Insurance) that the applicant needs to complete.

    NOTE: 

    USPS will pre-fill questions #6 and #8 (remarks) on the CMS-40B form and input the following remarks “PSRA Special Enrollment Period”.

  • •

    An extra copy of the notice, along with the CMS-40B form for the applicant to submit to SSA.

WBDOC receives the USPS SEP Enrollment and Notice

  • •

    WBDOC reviews the CMS-40B form and verifies the proof (copy of the original USPS notice) and scans it into Evidence Portal (EP).

  • •

    WBDOC processes the enrollment request via the Post Entitlement Online System (POS) and completes the Special Enrollment Period (SEP) Webpage for the USPS SEP enrollment request.

NOTE: 

If the beneficiary has Medicare through the Railroad, route the enrollment to the Field Office.

Field Office (FO) receives a CMS-40B form and notice for the USPS SEP Enrollment

The FO scans the CMS-40B form and proof (notification letter) into Evidence Portal (EP) or if received via WorkTrack, uploads the notice from WorkTrack into EP.

  • •

    The FO reviews the CMS-40B form and verifies the proof (a copy of the original USPS notice).

  • •

    The FO completes the enrollment process via POS and completes the SEP Webpage for the USPS SEP enrollment request.

  • •

    The FO sends the CMS-40B form and notice (proof) from WorkTrack to EP.

  • •

    If the beneficiary is vested with the Railroad, refer the beneficiary to the Railroad.

NOTE: 

Do not route the enrollment form (CMS-40B) or proof (notification letter) to the WBDOC. If the FO receives these enrollments, the FO is responsible for the development and processing.

Missing Documents - Development

WBDOC Instructions

  • •

    If the WBDOC receives only the CMS-40B form, the intake automation file will be instructed to look for the proof via the “data file” that will serve as secondary proof of eligibility prior to processing the enrollment request.

    • –

      If the “data file” is unable to verify the applicant, WBDOC will route the CMS-40B form, via WorkTrack, to the FO of jurisdiction for development of proof of eligibility.

  • •

    If the WBDOC receives only the proof of notice and not the CMS-40B form, they will route the proof to the jurisdictional FO for development via WorkTrack.

    NOTE: 

    The jurisdictional FO maintains responsibility for developing the CMS-40B and processing the USPS SEP enrollment. The FO should not route the enrollment request or documents back to the WBDOC.

Field Office Instructions

  • •

    If the FO receives only the CMS-40B form, the technician will be instructed to access SSA’s Online Retrieval System (ORS) for secondary proof of USPS SEP eligibility prior to processing the enrollment request. The secondary proof will be listed under the beneficiaries’ own SSN and Name titled “PSRA eligibility Notice.”

  • •

    If the FO is not able to verify the proof via ORS, the FO will be responsible to contact the applicant to develop for proof of eligibility.

  • •

    If the FO only receives proof of eligibility, they will be responsible to contact the applicant and develop for the CMS-40B form.

NOTE: 

After the development is completed, the FO of jurisdiction will be responsible for processing the USPS SEP enrollment request.

Equitable Relief - Field Office Instructions

If the annuitant/family member claims they never received the SEP enrollment package from USPS or received the notice package postmarked after September 30, 2024:

  • •

    USPS will provide a letter indicating there was a delay in communication to the annuitant/family member.

  • •

    The USPS letter will serve as proof of equitable relief.

  • •

    The FO technician will need to complete Form SSA-5002 (Report of Contact) to indicate why we are granting equitable relief to the individual.

  • •

    The FO will review the CMS-40B form and proof of eligibility and take the necessary action via POS to process the enrollment request. Scan the SSA-5002, CMS-40B and the USPS letter into EP.

  • •

    The SSA FO technician will add “Equitable Relief- USPS” as a Special Message on the MBR.

  • •

    The WBDOC will route all enrollment requests postmarked after September 30, 2024 to the FO.

Reference: See POMS HI 00830.000 for information on processing Equitable Relief inquiries.

Footnotes:

[1]

The term ‘Postal Service annuitant’ means an annuitant enrolled in a health benefits plan under chapter 89 of title 5, United States Code, whose Government contribution is required to be paid under section 8906(g)(2) of such title.

[2]

A member of family is defined in section 8901(5) of title 5 , United States Code.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805346
HI 00805.346 - Special Enrollment Period (SEP) for Eligible Postal Annuitants and Eligible Family Members to Enroll in Medicare Part B - 03/21/2024
Batch run: 10/10/2024
Rev:03/21/2024