References:
Public Law 117-108; Section 1862(b)(1)(E) of the Social Security Act (42 U.S.C. 1395y(b)(1)(E))
Background:
The Postal Service Reform Act of 2022 (H.R. 3076), signed into law on April 6, 2022, mandates that certain Medicare-eligible U.S. Postal Service (USPS) retirees and their eligible family members must enroll in Medicare Part B to participate in a Postal Service Health Benefits (PSHB) Program plan, effective January 1, 2025. However, there are key exceptions to this requirement:
- Postal Service annuitants not entitled to premium-free Medicare Part A or not enrolled in Medicare Part B by January 1, 2025.
- Postal Service employees who are at least 64 years old by January 1, 2025.
- Individuals residing outside the U.S. and its territories.
- Individuals receiving healthcare benefits from the Department of Veterans Affairs.
- Individuals eligible for Indian Health Service healthcare.
The Office of Personnel Management (OPM) is responsible for notifying eligible individuals of their qualification for this Special Enrollment Period (SEP) and providing the Social Security Administration (SSA) with a list of these individuals.
One-Time Medicare Part B Special Enrollment Period:
Under the Postal Service Reform Act of 2022, a one-time Special Enrollment Period (SEP) is being offered to eligible USPS annuitants and their family members. This SEP will be available from April 1, 2024, through September 30, 2024. This one-time opportunity will allow eligible individuals to enroll in Medicare Part B without incurring the usual penalties.
Eligibility for the SEP:
To be eligible for this special enrollment, individuals must meet the following criteria:
- Postal Service Annuitants: Must be entitled to premium-free Medicare Part A and must not be currently enrolled in Medicare Part B as of January 1, 2024.
- Family Members of Postal Service Annuitants: Must be a family member of a Postal Service annuitant and entitled to premium-free Medicare Part A, but not enrolled in Medicare Part B as of January 1, 2024.
Note:
Individuals who are only eligible for Medicare with a premium or those eligible for benefits as a working disabled individual are not eligible for this SEP.
Eligible individuals may also reenroll in Part B if they were previously enrolled.
Example:
A USPS employee retired in December 2023, became entitled to premium-free Medicare Part A when they turned 65 in 2021, but did not enroll in Medicare Part B. This individual qualifies for the SEP from April 1, 2024, through September 30, 2024, with Medicare Part B coverage beginning on January 1, 2025.
Effective Date for Medicare Part B Coverage:
For all eligible individuals enrolling in the one-time SEP, Medicare Part B coverage will take effect on January 1, 2025, regardless of when they enroll during the six-month SEP period.
Premium Surcharges and Penalties:
Postal Service annuitants and their family members who enroll in Medicare Part B during this SEP may be subject to late enrollment penalties. However, these penalties will be paid by the USPS directly to the Centers for Medicare & Medicaid Services (CMS), ensuring that enrollees are not burdened with these additional costs.
Examples of Retroactive Medicare Part A Enrollment:
Example 1:
Suzanne Jackson, a retired USPS employee, files for Medicare in December 2023, and her entitlement to premium-free Medicare Part A is retroactive to June 2023. Since Suzanne declined Medicare Part B enrollment, she is eligible for the USPS SEP for the remainder of the enrollment period, which runs from April 1 to September 30, 2024.
Example 2:
Mike Higgins, another retired USPS employee, files for Medicare in April 2024 and receives retroactive Medicare Part A coverage effective October 2023. Mike is eligible to enroll in Medicare Part B during the USPS SEP from April 1 to September 30, 2024.
Example 3:
Lisa Richards, a retired USPS employee, files for Medicare in August 2024, with retroactive entitlement to Medicare Part A starting in February 2024. Since Lisa’s Medicare Part A coverage did not begin by January 2024, she is not eligible for the USPS SEP.
Group Health Plan SEP vs. USPS SEP:
Some Postal Service annuitants may be eligible for both a Group Health Plan (GHP) SEP and the USPS SEP. If eligible for both, individuals should weigh their options carefully. Enrolling through the GHP may result in an earlier effective date for Medicare Part B coverage, but there may also be a premium surcharge. On the other hand, enrolling through the USPS SEP ensures coverage starting January 1, 2025, and any surcharge will be covered by the USPS.
USPS SEP Enrollment Process:
Starting March 15, 2024, USPS will mail enrollment packages to eligible retirees and their family members, detailing the USPS SEP. The package will include:
- Instructions for applying for the SEP.
- A pre-filled CMS-40B form (Application for Enrollment in Medicare Part B).
- A return envelope pre-addressed to the Social Security Administration’s Wilkes-Barre Direct Operations Center (WBDOC).
The WBDOC will process enrollment requests by verifying eligibility and completing the SEP enrollment via the Post Entitlement Online System (POS).
Field Office Instructions:
If the Social Security Field Office receives enrollment forms, they are responsible for verifying eligibility, completing the enrollment process, and scanning the necessary documentation into the Evidence Portal (EP).
Equitable Relief:
In cases where individuals do not receive their SEP enrollment package by the deadline or receive it late, USPS will issue a letter granting equitable relief. The Social Security Field Office will process these requests and ensure coverage is granted appropriately.
This special Medicare Part B enrollment opportunity ensures that USPS retirees and their families are covered under the new Postal Service Health Benefits (PSHB) Program starting in 2025, while avoiding unnecessary penalties.
