A Postal Service annuitant who, as of January 1, 2025, has no entitlement to premium-free Medicare Part A and is not enrolled in Medicare Part B.
A Postal Service employee who is, as of January 1, 2025, at least 64 years old. The individual is residing outside the U.S. and its territories. The individual is enrolled in health care benefits provided by the Department of Veterans Affairs. The individual is eligible for health services from the Indian Health Service.The legislation requires the Office of Personnel Management (OPM) to identify individuals who are eligible to enroll in Part B and notify them of their eligibility to enroll in this Special Enrollment Period. The notice will also serve to identify and inform SSA of individuals eligible to enroll.
The Postal Service Reform Act of 2022 establishes a one-time Medicare Part B Special Enrollment Period (SEP) for eligible Postal Service annuitants (e.g. certain retirees) and their eligible family members. The one-time SEP will run from April 1, 2024 through September 30, 2024.
For SSA purposes, the one-time SEP will be referred to as the USPS SEP, PSRA SEP or PSHB SEP.
Eligible individuals are those who are entitled to benefits under premium-free Medicare Part A but are not enrolled in Medicare Part B and wish to enroll or remain enrolled in their PSHB Program.
Individuals who are only eligible to enroll in premium HI for the aged or premium HI for the working disabled are not eligible for this SEP.
An individual is eligible for the SEP if:
As of January 1, 2024, they are a Postal Service annuitant who is entitled to benefits under premium-free Medicare Part A, and
is not currently enrolled in Medicare Part B.An individual is eligible for the SEP if:
As of January 1, 2024, is a member of family [2] of a Postal Service annuitant and is entitled to benefits under premium-free Medicare Part A, and
is not currently enrolled in Medicare Part B.Individuals may use this SEP to reenroll in Part B. While an individual is not eligible to enroll in this SEP if they are currently enrolled in Part B, they may be eligible for this SEP if they have been enrolled in Part B in the past, even after 1/1/24.
Example: A USPS employee retired in December 2023. The employee was 67 years old and a USPS annuitant as of January 1, 2024. The individual became entitled to benefits under premium-free Medicare Part A when they turned 65 in 2021. The individual qualifies for the USPS SEP since they meet the qualifications and are not currently enrolled in Medicare Part B. The individual can enroll in Medicare Part B during the six-month SEP (April 1, 2024 through September 30, 2024) and their Medicare Part B coverage will begin January 1, 2025.
The individual’s Medicare Part B coverage will begin on January 1, 2025, regardless of when they enrolled during the six-month SEP.
Eligible Postal Service annuitants (e.g. certain retirees and their eligible family members) who enroll in Medicare Part B via the one-time SEP may be subject to Part B late enrollment penalties (LEP). The USPS will pay these penalties directly to the Centers for Medicare & Medicaid Services.
Example: Suzanne Jackson is retired from the USPS and receives an annuity from OPM. Suzanne attained age 65 in June 2022, but never enrolled in Medicare or filed a Retirement Insurance Benefit (RIB) claim until December 21, 2023 when Suzanne files for both RIB and premium-free Medicare Part A. Suzanne declined to enroll in Medicare Part B. Suzanne is fully insured and the claim is allowed. However, Suzanne’s claim is not updated to the Master Beneficiary Record (MBR) until February 16, 2024. Once the claim updates on February 16, 2024, the MBR will reflect a HI-START of June 2023 (6 months retroactive to the SMI-FILING of December 2023), and a SMI refusal. Suzanne would then be eligible for the USPS SEP for the remainder of April through September 2024
Example: Mike Higgins is retired from the USPS and receives an annuity from OPM. Mike attained age 65 in June 2022, but never enrolled in Medicare or filed a RIB claim until April 22, 2024 when Mike files for both RIB and premium-free Medicare Part A. Mike is fully insured, and Mike’s claim is allowed. The MBR reflects a HI-START of October 2023 (6 months retroactive to the SMI-FILING of April 2024), and a SMI refusal. Mike would then be eligible for the USPS SEP for the remainder of April through September 2024.
Example: Lisa Richards is retired from the USPS and receives an annuity from OPM. Lisa attained age 65 in June 2022, but never enrolled in Medicare or filed a RIB claim until August 21, 2024 when Lisa files for both RIB and premium-free Medicare Part A. Lisa is fully insured, and the claim is allowed. The premium-free HI START date is effective February 2024 (6 months retroactivity). In this scenario, since Lisa is not eligible for premium-free HI until February 2024 and has no premium-free HI coverage in January 2024, Lisa is NOT eligible for the USPS SEP. Instead, SSA’s Enrollment (EN) software on an initial claim would give Lisa Part B coverage in February 2025, with a SMI-PERIOD = ‘A’ (assumed enrollment period – deemed to have filed in the 2025 GEP during January), and Lisa may incur a late enrollment penalty if Lisa files for Part B.
Eligible Postal Service annuitants may also simultaneously be eligible for a GHP SEP to enroll in Medicare. If this is the case, technicians should educate individuals on their choice. Should they choose to enroll using the GHP, their coverage effective date depends on the month of enrollment (see POMS HI 00805.276). They may or may not have a premium surcharge. Should they enroll in the PSRA SEP, their coverage will begin January 1, 2025, and any applicable surcharge will be paid by the USPS. USPS will pay these penalties directly to the Centers for Medicare & Medicaid Services and therefore, front end development is not required by technicians for premium surcharge rollback (see HI 00805.280).
USPS sends an SEP enrollment package to all eligible United States Postal Service annuitants and their family members starting on March 15, 2024 to inform them of the one-time Special Enrollment Period that will run April 1, 2024 through September 30, 2024. The enrollment package will include the following items:
A notice with instructions on how to apply for the USPS SEP; andA return envelope addressed to the following address: Social Security Administration
Wilkes-Barre Direct Operations Center
PO Box 67650
Wilkes-Barre PA 18767-7650
A pre-filled CMS-40B form (Application for Enrollment in Medicare Part B (Medical Insurance) that the applicant needs to complete.
USPS will pre-fill questions #6 and #8 (remarks) on the CMS-40B form and input the following remarks “PSRA Special Enrollment Period”.
An extra copy of the notice, along with the CMS-40B form for the applicant to submit to SSA.WBDOC receives the USPS SEP Enrollment and Notice
WBDOC reviews the CMS-40B form and verifies the proof (copy of the original USPS notice) and scans it into Evidence Portal (EP).
WBDOC processes the enrollment request via the Post Entitlement Online System (POS) and completes the Special Enrollment Period (SEP) Webpage for the USPS SEP enrollment request.
If the beneficiary has Medicare through the Railroad, route the enrollment to the Field Office.
Field Office (FO) receives a CMS-40B form and notice for the USPS SEP Enrollment
The FO scans the CMS-40B form and proof (notification letter) into Evidence Portal (EP) or if received via WorkTrack, uploads the notice from WorkTrack into EP.
The FO reviews the CMS-40B form and verifies the proof (a copy of the original USPS notice).The FO completes the enrollment process via POS and completes the SEP Webpage for the USPS SEP enrollment request.