The bill adds a new special enrollment period (SEP) to Medicare Part B for people who are enrolled in COBRA continuation coverage or who enroll in COBRA immediately after losing other coverage. The SEP covers every month the person is in COBRA and the three months after the last month of COBRA, but the bill limits the SEP to a single use per beneficiary in their lifetime.
The bill also says the Medicare Part B coverage start date for these enrollees is the first day of the month after they enroll.
Separately, the bill amends ERISA, the Public Health Service Act, and the Internal Revenue Code to bar COBRA continuation plans from reducing or terminating benefits on the basis that a beneficiary is eligible for but not yet enrolled in Part B. It requires the Department of Labor, with HHS, to update COBRA notices by January 1, 2026 to explain how Medicare secondary payer rules interact with COBRA coverage.
These changes shift specific administrative and cost-coordination responsibilities to plan sponsors and administrators while creating a defined pathway for COBRA enrollees to get Part B without automatic premium penalties.
At a Glance
What It Does
Creates a new Medicare Part B special enrollment period tied to periods of COBRA continuation coverage (including federal and comparable state continuation). The SEP runs during months of COBRA coverage and for three months after COBRA ends, is usable once per lifetime, and triggers Part B coverage starting the first day of the month after enrollment.
Who It Affects
COBRA enrollees who become or are Medicare-eligible, employer group health plans and COBRA administrators who must maintain benefits and update notices, and federal agencies (HHS, DOL, Treasury) that oversee coordination and guidance.
Why It Matters
This bill reduces the risk of Part B late-enrollment penalties for people on COBRA while creating legal constraints on how COBRA coverage coordinates with Medicare, which can shift costs and administrative complexity between Medicare and employer-sponsored continuation plans.
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What This Bill Actually Does
The central change is an explicit special enrollment period (SEP) for Medicare Part B for people who are enrolled in COBRA continuation coverage when they first become eligible for Medicare or who enroll in COBRA immediately after losing prior coverage. The SEP covers every month during which the person has any COBRA coverage and then extends for three additional months after the last COBRA month.
The bill caps use of this SEP to one time per individual during their lifetime, preventing repeated enrollments under the same rule. When an individual uses the SEP, the Part B coverage period begins on the first day of the month after they enroll.
To protect COBRA enrollees who delay Part B enrollment, the bill amends the Part B premium rules so that months of demonstrated COBRA coverage can be considered when determining any premium increase under current law. In other words, an enrollee can show they were in COBRA for months in question so Part B enrollment timing tied to COBRA does not automatically trigger higher premiums under the statute.
The bill also establishes a January 1, 2026 effective floor: the definition of "COBRA continuation coverage" referenced in the new SEP covers COBRA under federal law, federal employee continuation under 5 U.S.C. 8905a, and similar state continuation laws starting on or after that date.Because the SEP could change which payer is primary for particular claims, the bill explicitly amends ERISA, the Public Health Service Act, and the Internal Revenue Code to prohibit COBRA continuation plans from reducing or terminating benefits on the basis that an individual is eligible for but not enrolled in Part B. Those amendments require COBRA plans to continue paying benefits as if the individual were not Medicare-eligible—until the individual actually enrolls in Part B; once the individual enrolls, the plan may terminate or reduce continuation coverage in accordance with existing rules.
Finally, the bill directs the Department of Labor, working with HHS, to update the written COBRA notices to explain Medicare secondary payer rules and how they apply to COBRA coverage by January 1, 2026, which creates a compliance and education deadline for plan administrators.
The Five Things You Need to Know
The SEP covers each month the individual is enrolled in COBRA continuation coverage and the three-month period beginning the month after the last month of COBRA coverage.
Each individual may use the COBRA-linked SEP only once in their lifetime.
The bill defines "COBRA continuation coverage" to include COBRA under PHSA section 2791(d)(4), federal continuation under 5 U.S.C. 8905a, and comparable state continuation laws, effective for continuation coverage beginning on or after January 1, 2026.
Amendments to ERISA, the PHSA, and the Internal Revenue Code require COBRA continuation plans to provide benefits as if the individual were not eligible for Part B—they may not reduce or terminate benefits solely because the person is eligible for but not enrolled in Part B.
The Department of Labor, in consultation with HHS, must update the COBRA written notices by January 1, 2026 to explain Medicare secondary payer rules as they apply to COBRA.
Section-by-Section Breakdown
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Short title
Provides the bill's citation as the "Medicare Enrollment Protection Act of 2025." This is purely stylistic but signals the bill's focus on enrollment protections tied to Medicare Part B and COBRA.
Adds a COBRA-linked special enrollment period for Part B
Inserts a new paragraph (5) into section 1837(i) establishing the SEP. The SEP applies either when an individual is on COBRA at the time they first meet existing Medicare enrollment criteria, or when they enroll in COBRA immediately after previously meeting those criteria. It defines the SEP window to include months of COBRA coverage and a three-month ‘‘run‑on’’ after COBRA ends, limits SEP use to once in a lifetime, and ties the term "COBRA continuation coverage" to federal COBRA, federal employee continuation, and comparable state laws beginning Jan 1, 2026. Practically, this provision creates a predictable enrollment window linked to COBRA status and narrows opportunities for repeated re-entry under the same rule.
Part B coverage start date for COBRA-linked enrollments
Modifies the statute that determines when Part B coverage begins for special enrollments so that, for enrollments under the new COBRA-linked SEP, the coverage period starts on the first day of the month following the month in which the individual enrolls. This is an operational detail that affects claim processing, premium billing, and retroactive coverage considerations.
Premium treatment for COBRA months
Adds the new SEP to the Part B premium statute so that months of demonstrated COBRA coverage are considered when calculating premium increases that otherwise could result from late enrollment. The change signals Congress's intent that COBRA enrollment should, in certain cases, protect beneficiaries from Part B premium penalties tied to delayed enrollment.
Prohibits COBRA plans from reducing benefits based on Part B eligibility
Adds a special coordination-of-benefits rule to ERISA section 607, PHSA section 2208, and IRC section 4980B(g) stating that COBRA continuation coverage cannot reduce or terminate benefits solely because an individual is eligible for but not enrolled in Part B. The rule requires COBRA plans to pay benefits as if the individual were not Medicare-eligible until the individual actually enrolls in Part B; it preserves a plan's existing ability to terminate continuation coverage after a beneficiary actually enrolls. These parallel amendments create consistent obligations across the major federal regimes that govern group health continuation coverage.
COBRA notice update deadline
Directs the Secretary of Labor, in consultation with HHS, to update the COBRA written notices required under ERISA section 606 so they explain Medicare secondary payer rules and how those rules apply to COBRA continuation coverage, with a compliance date of January 1, 2026. This creates a concrete compliance task for plan administrators and communicates the policy change directly to beneficiaries through required notices.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- COBRA enrollees who become Medicare-eligible: They gain a defined SEP tied to their COBRA period and protection from automatic Part B premium increases when they can show months of COBRA coverage.
- Individuals who delay Part B enrollment while on COBRA: The bill reduces the risk of late-enrollment penalties and clarifies when Part B coverage will start after enrollment.
- Medicare beneficiaries needing predictable enrollment rules: Providers and billing offices benefit from clearer coverage start-dates for Part B in these narrow circumstances, reducing claim disputes tied to timing.
Who Bears the Cost
- Employer-sponsored plans and COBRA administrators: They must maintain benefits for individuals who are eligible for but not enrolled in Part B, potentially increasing plan-paid claim costs and coordination workloads.
- Plan sponsors subject to notice updates: Employers and administrators must implement updated COBRA notices by Jan 1, 2026 and field beneficiary questions about coordination with Medicare.
- Federal agencies and regulators: HHS, DOL, and Treasury will need to issue guidance and monitor compliance across ERISA, PHSA, and tax regimes, which creates administrative and oversight costs.
Key Issues
The Core Tension
The bill balances two legitimate goals—protecting Medicare-eligible people on COBRA from Part B penalties and preventing Medicare from absorbing costs that employer continuation plans historically cover—but doing so forces a trade-off: it protects individual enrollment rights while shifting financial and administrative burdens onto COBRA plans and plan administrators, creating a tension between beneficiary access and employer plan cost allocation.
The bill resolves a narrow access problem but raises practical and enforcement questions. Requiring COBRA continuation plans to pay benefits ‘‘as if’’ the enrollee were not Medicare-eligible until they actually enroll shifts primary payment exposure back onto employer plans for periods when Medicare might otherwise be primary.
That can increase claims costs for plans and lead to disputes about retroactivity and reimbursement once the beneficiary enrolls in Part B.
Implementation will hinge on rules of proof and timing: plan administrators will need to verify COBRA enrollment periods, beneficiaries will need clear guidance on evidence required to avoid premium increases, and claims systems will need to track shifting primary/secondary status across months. The bill sets a Jan 1, 2026 floor for which continuation laws qualify, but it leaves open how to treat pre-2026 continuation coverage and what constitutes a "comparable" state law, which could invite litigation or require additional regulatory clarification.
Finally, the one-time lifetime use restriction reduces potential gaming but creates edge cases where beneficiaries who decline SEP use early may later lack any remedy despite new qualifying circumstances.
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