Medicare Enrollment Protection Act of 2025
Medicare Enrollment Protection Act of 2025 would create a new, one-time special enrollment period (SEP) for Medicare Part B specifically for people who are enrolled in COBRA continuation coverage. The SEP would allow eligible individuals to sign up for Medicare Part B during a window that runs from any month they are on COBRA plus the three months after the last COBRA month. The bill also strengthens how COBRA interacts with Medicare and other federal health programs by ensuring COBRA benefits aren’t automatically reduced or terminated merely because someone is Medicare-eligible, and it requires updated notices explaining Medicare secondary payer rules. The changes would apply to COBRA coverage that begins on or after January 1, 2026. The overall aim is to smooth transitions between employer-based coverage (via COBRA) and Medicare, reduce coverage gaps, and clarify payer coordination rules. In short, the bill is about giving people on COBRA a clear, protected path to enroll in Medicare without losing COBRA protections or facing premium penalties tied to delayed enrollment, and it coordinates how COBRA and Medicare work together.
Key Points
- 1Special enrollment period for COBRA enrollees: Adds 1837(i)(5) to create a one-time SEP for individuals who are on COBRA or who become COBRA-enrolled as they become Medicare-eligible. The SEP lasts for each month they are on COBRA plus the three months after the final COBRA month.
- 2Scope and definition of COBRA: COBRA continuation coverage is defined to include standard employer-based COBRA (ERISA), federal employee continuation coverage, and similar state continuation laws, with coverage beginning on or after January 1, 2026.
- 3Start of Part B coverage during SEP: For individuals using the SEP, Medicare Part B coverage would begin the first day of the month after they enroll.
- 4Premium protections during SEP: Months in which the individual demonstrates COBRA enrollment would not cause increases in Part B premiums due to late enrollment penalties; the bill specifies how premiums are determined for these months.
- 5Coordination of benefits across multiple laws: The bill adds explicit coordination rules across ERISA (detailed in ERISA section 607), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC) to prevent COBRA benefits from being reduced or terminated merely because the individual is Medicare-eligible, while allowing COBRA to continue or terminate as allowed for those who enroll in Part B.
- 6Updated COBRA notices: Requires updating COBRA-related notices by January 1, 2026 to explain Medicare secondary payer rules under Medicare and the interaction with COBRA, in consultation with the Department of Labor and Health and Human Services.