The Consolidated Appropriations Act is a very long and very arduous document that discusses many of the new changes to healthcare policies and funding. It goes into great detail with a significant amount of legal language that can be difficult for the average Medicare beneficiary to translate.

In this article, we’ll go over what the CAA is and how it will affect Medicare in 2023. This way you can enter the new year knowing exactly what to expect from your Medicare coverage. Let’s dive in.

What is the Consolidated Appropriations Act?

The CAA is an omnibus spending bill that includes twelve bills to mark budgets and funding to prevent a government shutdown. For this article, we’re going to focus on the impact this act has on Medicare and health policy and funding. The effects of this act will affect the cost of payments for services and medical materials in 2023 which is an important thing for Medicare beneficiaries to know.

As part of the funding declared in the act, the Centers for Medicare and Medicaid Services (CMS) received a total of $4 billion. This marks a $50 million increase for CMS administrative services. In addition to funding, the bill also made changes to help with Medicare enrollment and eligibility rules.

What does the Consolidated Appropriations Act impact?

The CAA covers twelve bills that cover spending for a wide range of areas. The twelve areas where funding is discussed include:

●     Agriculture, Rural Development, Food, and Drug Administration, and Related Agencies;

●     Commerce, Justice, Science, and Related Agencies;

●     Energy and Water Development and Related Agencies;

●     Financial Services and General Government;

●     Interior, Environment, and Related Agencies;

●     Labor, Health and Human Services, Education, and Related Agencies;

●     Transportation, Housing and Urban Development, and Related Agencies;

●     Defense;

●     Homeland Security;

●     Legislative Branch;

●     Military Constriction and Veteran Affairs;

●     State and Foreign Operations.

Consolidated Appropriations Act’s impact on Medicare

In response to the growing sentiment to increase and expand healthcare for more people, the Consolidated Appropriations Act set standards to simplify the enrollment process for those seeking Medicare coverage. It also expanded coverage for immunosuppressive drugs for eligible beneficiaries. Both these changes will help make affordable healthcare more accessible to an increased population of Americans.

Rule changes for Medicare under the Consolidated Appropriations Act

The two main changes to Medicare enrollment, eligibility, and coverage are found in the bill. These include Section 120 of Title I of Division CC of the CAA as well as Section 402 of the CAA. In addition to these rules, some non-CAA changes were finalized including:

●     Adjustment regulations reference enrollment pages;

●     Technical change related to the Medicare premium payments by state.

 Let’s look into the specifics of what these sections of the CAA cover and their impact on Medicare.

Section 120 of Title I of Division CC of the CAA

This section specifically addresses changes to Original Medicare. Through this portion of the CAA, effective dates for coverage are revised. It also gives the Secretary of the Department of Health and Human Services the authority to change and establish new Medicare Special Enrollment Periods (SEPs) for those who qualify. Qualification for new SEPs is based on exceptional conditions and circumstances.

Section 402 of the CAA

This portion of the CAA covers the new inclusion of coverage for immunosuppressive drugs under Medicare Part B for eligible beneficiaries. This is a direct response to the old rule that had Medicare coverage for those with End-Stage Renal Disease (ESRD) end 36 months after receiving a kidney transplant.

Important things to know

The takeaway from all this is that the Consolidated Appropriations Act will affect enrollment and immunosuppressive drug coverage under Medicare. Let’s take a more in-depth look into how these changes will influence Medicare beneficiaries in 2023.

Enrollment simplification

The CAA bill and the changes it made to Medicare expanding coverage. This resulted in the CMS issuing an updated revision of Medicare’s rules for enrollment and eligibility. These changes are being implemented to help make the entire enrollment process easier for seniors. Here’s what these changes accomplish:

●     Medicare coverage starts the month after you enroll beginning January 1, 2023. Medicare coverage will become effective the month after enrollment for individuals enrolling in the last three months of their IEP or in the GEP, thereby reducing any potential gaps in coverage;

●     Expanded access during Medicare Special Enrollment Periods;

●     Allowing for Medicare Part B late enrollment for seniors without penalization;

●     Extended coverage for immunosuppressive drugs for those who receive a kidney transplant.

Increased eligibility

The new rules for Medicare as a result of the Consolidated Appropriations Act are increasing eligibility through something called a “state buy-in”. This increases eligibility by affecting the states’ payment for Medicare Part A and Part B premiums specifically for low-income beneficiaries. This rule, affecting 10 million individuals eligible for Medicare, consolidates regulations with federal, operations and policies.

The result of this consolidation offers increased access to health coverage specifically for marginalized and low-income individuals. With these changes, there will be an increase in health equity and coverage. Through these changes, the CMS is implementing improvements to increase transparency for all involved in the Medicare process while improving accountability for state payments for premiums for low-income beneficiaries.

Exceptional circumstances for Special Enrollment Period

Part of the changes to Medicare includes the Secretary of the Department of Health and Human Services receiving the authority to establish Special Enrollment Periods for those who meet exceptional circumstances. Those who are eligible won’t have to wait until the next General Enrollment Period (GEP) to enroll in Medicare coverage and won’t have to pay late enrollment penalties. Through these changes, the CMS hopes to drastically reduce gaps in coverage for seniors while also increasing eligibility. The following exceptional circumstances are currently being finalized by the Secretary:

Emergency or disaster

Those who are unable to or miss their enrollment due to emergencies or disasters declared by federal, state, or local governments will be eligible for a new SEP. The new rule will grant an additional 6 months after the emergency.

Health plan or employer error

Eligible beneficiaries will receive an additional 6 months after notifying the Social Security Administration of an error made by their health plan or employer regarding their Medicare enrollment. The beneficiary must prove that an error was made to qualify.

Formerly incarcerated individuals

This new Medicare rule is specifically for those released from correctional facilities. Eligible beneficiaries will receive an extended 12-month period to enroll in Medicare coverage without facing late enrollment penalties.

Termination of Medicaid coverage

This new rule is specifically for those who are applying for Medicare after the termination of Medicaid coverage. This means you can apply for Medicare when your Medicaid ends or enroll retroactively to eliminate gaps in healthcare coverage and avoid penalties.

Other exceptional conditions

With this new Medicare rule, beneficiaries can receive an extended 6-month period to enroll on a case-by-case basis.

Impact on immunosuppressive drug coverage

The other main change that Medicare beneficiaries will see in 2023 is expanded coverage of immunosuppressive drugs. Medicare coverage for those with End-Stage Renal Disease can lose their coverage 36 months after receiving a kidney transplant until they are eligible again due to age or disability. Through the CAA, a new immunosuppressive drug benefit provides improved access to beneficiaries to enroll past the 36-month post-transplant mark. The new benefit under Medicare Part D covers the following:

●     This only applies to immunosuppressive drugs;

●     Does not extend to other Part B services or benefits;

●     Those eligible can enroll or disenroll at any time without SEPs;

●     Individuals cannot be enrolled in any other form of coverage;

●     Lower costs than the standard Part B premium;

●     Those enrolled only pay 20% of the Medicare-approved amount after meeting the plan’s deductible.

What does this all mean for you?

Navigating the intricacies of the changes resulting can be a challenge. Knowing that you are making the right decisions and adhering to new guidelines can cause quite a bit of stress. With Hella Health, you can use tools to find the right options for you while avoiding any penalties with friendly and helpful reminders. Hella Health strives to offer helpful advice and digestible information to keep you well-versed in all things Medicare. It is a great resource for those worried or unsure about the Consolidated Appropriations Act’s impact on Medicare in 2023.