Important Final Rule Streamlines Enrollment Into Medicare Savings Programs

This week, the Centers for Medicare & Medicaid Services (CMS) finalized a long-awaited rule that will make it easier for people with Medicare to be and stay enrolled in a Medicare Savings Program (MSP). CMS estimates that this rule will result in 860,000 more individuals participating in MSPs.

MSPs are a set of financial assistance programs that help pay Medicare costs for people with few resources, helping enrollees afford their health coverage and other basic needs. Despite their value, an estimated 40% of those who are eligible—2.5 million people—are not enrolled. This may be due to lack of information about the programs and how to sign up, or difficulty navigating an enrollment process that is notoriously complex.

To help address these access problems, the final rule requires states to make use of existing eligibility information from the Social Security Administration (SSA). SSA oversees enrollment into the low-income subsidy (LIS)—also called “Extra Help”—a program that helps people with Medicare afford their prescription drugs and has similar application requirements as MSPs. In addition, the rule reduces the burden on applicants to produce certain types of documentation prior to enrollment, ensures more people have an earlier effective date for their MSP coverage, and automatically enrolls Medicare-eligible people receiving Supplemental Security Income (SSI) into the MSP known as the Qualified Medicare Beneficiary (QMB) program.

At Medicare Rights, we strongly supported the proposed rule and submitted comments to that effect. But the final rule does not go as far as the proposals. The draft rule also dealt with burdensome redetermination processes, important provisions that are not addressed in the final rule. This leaves people with both Medicare and Medicaid at risk of losing their Medicaid and MSP coverage because they have to fill out burdensome eligibility paperwork multiple times a year. We will continue to urge CMS to address this issue.

The effective date for key provisions that will reduce burdens on applicants is also later than first proposed. Initially, the latest compliance date was to be 12 months after publication of the final rule. Now, the latest compliance date is April 2026 for some provisions. While this extension gives states more time to come into compliance, and many states may choose to act more quickly, it delays access to the streamlined processes for people in states that do not. We will continue to urge states to act sooner rather than later to ensure beneficiaries get the help they need.

Read the final rule and factsheet.

Read our comments on the proposed rule.

Read more about the importance of MSPs and LIS.