Equitable relief is available for people who, from January 1, 2022 onward, missed enrollment in Medicare because of SSA telephone issues. Because the Social Security Administration (SSA) national 800 number and field offices both had—and continue to have—technical difficulties with their phone and fax systems since the start of the calendar year, the Centers for Medicare & Medicaid Services (CMS) is providing equitable relief to anyone who was unable to enroll in Medicare because of problems getting through to SSA. The equitable relief runs through December 31, 2022, and applies to anyone who could not enroll (or disenroll) in Part B or in premium Part A during a period of enrollment eligibility because of problems with phone or fax communication with SSA. Although this equitable relief will primarily affect people who missed the January 1 – March 31 General Enrollment Period (GEP), it also applies to individuals who missed an Initial Enrollment Period (IEP) that encompasses dates on or after January 1, 2022, as well as individuals who were unable to make changes based on the employment-related Special Enrollment Period (SEP).
Individuals seeking equitable relief can contact either the national SSA phone number, 1-800-772-1213, or their local SSA office. Equitable relief will be granted on a case-by-case basis. From a review of the guidance (EM-22020) to SSA offices, it appears that the following requirements will apply:
The individual must have been in an enrollment period on or after January 1, 2022. Since everyone eligible for Medicare has an enrollment period from January 1 through March 31, this requirement will be met by anyone missing an enrollment in the January-March timeframe. Advocates should be aware that, because the guidance notes that the technical problems are ongoing, it may be possible to seek equitable relief for individuals who miss a deadline after March 31 if they encounter phone or fax problems that cause them to miss their enrollment window.
The individual must assert that they attempted to reach SSA by phone or attempted to fax information and encountered difficulties, e.g., couldn’t get through, the call got dropped or cut off, etc., and they were unable to timely enroll or disenroll. Although it would be helpful if the individual had notes on the dates or number of times they called, it does not appear that SSA will require that kind of specificity if the individual does not have it available. The instructions to SSA staff state: We encourage technicians to be as responsive and flexible as possible when a current or new beneficiary affected by telephonic technical issues contacts us for any missed enrollment opportunity due to being impacted by SSA’s telephonic technical issues. Advocates should encourage individuals who missed a deadline to seek equitable relief even if they cannot recollect details about the calls they made. Note also that, although online application processes have been available, the guidance does not require individuals to justify why they did not or could not use online enrollment options. It is enough for the individual to have tried phone access and been unsuccessful.
Note that normal rules apply with respect to the effective date of an enrollment. Thus, if an individual obtains equitable relief for a missed GEP enrollment, the first day of coverage will be no earlier than July 1, 2022, which would have been the first day if the individual had timely enrolled. Additional details are available in the guidance.