CMS Moves to Diminish Medicare Coverage Delays, Barriers to Access, Following ASCO Comments

November 8, 2022

The Centers for Medicare & Medicaid Services (CMS) finalized changes to Medicare enrollment policy that will make Medicare Part A and Part B coverage effective sooner after an individual enrolls in the program, eliminating gaps or delays in coverage. The Association for Clinical Oncology (ASCO) advocated for these changes in comments on the “Implementing Certain Provisions of the Consolidated Appropriations Act, 2021” proposed rule.

Currently, Medicare enrollees may have to wait up to six months for traditional Medicare coverage to begin, depending on the circumstances in which they enroll. Beginning January 1, 2023, Medicare coverage will become effective the month after enrollment.

In its comments to the agency, ASCO strongly supported the establishment of special enrollment periods (SEPs) for individuals in exceptional circumstances, so that they can avoid having to wait for the general enrollment period or incurring a late enrollment penalty. Following ASCO’s comments, CMS finalized the following SEPs:

  • Individuals Affected by an Emergency or Disaster
  • Health Plan or Employer Error
  • Formerly Incarcerated Individuals
  • Coordinate with Termination of Medicaid Coverage
  • Other Exceptional Conditions (on a case-by-case basis)

ASCO believes that all eligible individuals should be able to apply, enroll in, and receive Medicare coverage benefits in a timely and streamlined manner that promotes equitable coverage, especially for individuals with a cancer diagnosis, or who are at increased cancer risk. ASCO applauds CMS for implementing policy that diminishes delays and reduces barriers to accessing Medicare coverage.

Read ASCO’s full comment letter.

Read CMS’ fact sheet.

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