BENEs Act Improves & Simplifies Medicare Part B Eligibility Notices & Enrollment

BENEs Act Improves & Simplifies Medicare Part B Eligibility Notices & Enrollment

The basic rules underpinning the Part B enrollment system were developed more than fifty years ago, when Medicare was first established. The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (H.R. 2575) offers long-overdue solutions to modernize and simplify Part B enrollment. Through bipartisan, low-cost reforms, the BENES Act shields people with Medicare from steep premium penalties and fills needless gaps in coverage.

 

While many individuals are automatically enrolled in Medicare because they are receiving Social Security benefits, an increasing share of newly eligible beneficiaries must actively enroll in the benefit. Knowing whether and when to enroll in Part B requires that a person understand when to sign up during time-limited windows, how their current insurance will work with Medicare, and what penalties may result if enrollment is delayed. The consequences of missteps can be significant and often lead to a lifetime of higher Part B premiums.

 

In 2014, 750,000 people with Medicare were paying a Part B Late Enrollment Penalty (LEP) and the average LEP amounted to nearly a 30% increase in a beneficiary’s monthly premium.(1) In addition to this considerable penalty, many retirees and people with disabilities face significant out-of-pocket health care costs, gaps in coverage, and barriers to care continuity resulting solely from honest enrollment mistakes.

 

The BENES Act significantly alleviates these challenges. H.R. 2575 fills long-standing gaps in notice and education for those approaching Medicare eligibility and aligns and simplifies Part B enrollment periods. Taken together, these changes will help prevent costly enrollment slipups among the 10,000 people becoming Medicare eligible each day.

 

For people who are not auto-enrolled in Medicare, there is virtually no communication that provides education on when and how to enroll in Medicare or what may result from delayed enrollment. As a result, many of our organizations hear from older adults and people with disabilities who wrongly believed that because they had existing insurance, like COBRA benefits, retiree insurance, or a Marketplace plan, they did not need to enroll in Part B. These individuals often face severe consequences that prevent them from receiving urgently needed health care.

 

The BENES Act requires that a clear and detailed notice explaining Part B enrollment rules is mailed to all individuals aging into Medicare and those nearing eligibility because they receive Social Security disability benefits, aligning the mailing of this Medicare notice with existing Social Security notices, where possible. Additionally, H.R. 2575 brings Part B enrollment periods in line with those of private insurance products, including Medicare Advantage (MA) and Part D prescription drug plans, allowing for more uniform education and outreach. The BENES Act also guarantees that people with Medicare will no longer go without needed outpatient care due to needlessly delayed coverage start dates.

 

Far too many people with Medicare are irreversibly harmed due to an outdated Part B enrollment system. The BENES Act presents an important opportunity for members of Congress to advance commonsense, bipartisan reforms that are in the best interest of the many millions of Americans who will soon come to rely on Medicare.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.