BENES Act Clarifies and Improves Medicare Enrollment

Joanna RemziMedicare WatchLeave a Comment

The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act is bipartisan legislation to modernize the Part B enrollment process recently introduced in the House of Representatives and the Senate. Developed by the Medicare Rights Center and championed by Congressmen Raul Ruiz (D-CA) and Patrick Meehan (R-PA) as well as Senators Bob Casey (D-PA) and Chuck Schumer (D-NY), the bill aims to prevent costly Part B enrollment mistakes.

People receiving Social Security benefits are automatically enrolled in Part B. Increasingly, however, many Americans are working longer, delaying retirement, and deferring Social Security benefits. Unlike those who are auto-enrolled, these individuals must make an active Medicare enrollment choice. Deciding whether and when to enroll in Medicare involves many complex rules, and inappropriately delaying Part B can lead to a lifetime of higher Part B premiums, gaps in coverage, and barriers to accessing needed care.

The BENES Act is composed of three substantive parts, intended to:

  • 1. Fill notification and education gaps

    Through the BENES Act, the federal government will provide two notices to individuals nearing Medicare eligibility about Part B enrollment: one sent six months ahead of a person’s Initial Enrollment Period (IEP) and another notification one month before an individual’s IEP. The bill seeks to prevent problematic enrollment mistakes through adequate education and clarification of Part B enrollment rules.

  • 2. Fix fragmented and outdated Part B enrollment periods

    The BENES Act eliminates coverage gaps in the 5th, 6th, and 7th month of a person’s IEP and in the annual General Enrollment Period (GEP). Furthermore, it aligns the GEP with existing annual enrollment periods for Medicare Advantage and Part D prescription drug plans. The current Part B enrollment periods, both IEP and GEP, were established when Medicare was created in 1965—the BENES Act provides a long overdue update to how the enrollment periods are structured.

  • 3. Strengthen systems for relief

    The BENES Act broadens the circumstances in which beneficiaries may request equitable relief from Part B premium penalties and gaps in coverage. It standardizes the process for making equitable relief requests and increases transparency. Many Part B enrollment mistakes result from misinformation, oftentimes provided by a trusted source, such as an employer, health plan, or state agency. The BENES Act ensures that individuals who are misled have a consumer-friendly avenue through which to seek relief.

The BENES Act is critical to solving many of the pitfalls associated with Part B enrollment. The 10,000 people who turn 65 daily will find enrolling in Medicare easier as a consequence of the BENES Act. Medicare enrollment rules are complicated and mastered by very few; thus, the BENES Act is a big leap in the right direction.

Take Action

We need your help to pass the BENES Act! Write to your members of Congress and urge them to co-sponsor the BENES Act and improve the Part B enrollment process for the 10,000 people aging into Medicare each day.


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