Medicare Program: Special Enrollment Periods and Waiting Period

These rules provide an additional way for certain disabled individuals under age 65 to qualify for special enrollment periods (SEPs); extend from 1991 through 1998 the period during which certain disabled individuals under age 65 who are covered under large group health plans (LGHPs) may qualify for SEPs; and make clear that a second 24-month waiting period is not required for disability-based reentitlement if the current impairment is the same as, or directly related to, the impairment on which the previous period of entitlement was based. The changes made by these rules conform the HCFA regulations to certain provisions of the Omnibus Budget Reconciliation Acts of 1987, 1989, 1990, and 1993 (commonly referred to as OBRA '87, OBRA '89, OBRA '90, and OBRA '93, respectively), and the Social Security Act (SSA) Amendments of 1994 (Pub. L. 103-432). In OBRA '93, Congress amended section 1862(b) of the Social Security Act (the Act), to extend through September 30, 1998 the Medicare Secondary Payer (MSP) provisions for disabled beneficiaries. Congress did not make a conforming amendment to section 1837(i) of the Act, which authorizes SEPs for disabled beneficiaries who stop working. However, the SSA Amendments of 1994 made the conforming change to section 1837(i), retroactive to the OBRA '93 effective date. The purpose of the special enrollment period amendments is to ensure that a disabled individual under age 65 who meets the conditions for enrollment in Medicare Part B will be able to enroll as soon as his or her group health plan coverage based on current employment ends; and to extend until September 30, 1998 the protection afforded by the special enrollment periods to disabled individuals covered under LGHPs.