Making Medicare Enrollment Clear & Simple ~ Support the BENES Act (S.3236/H.R.5772)

The enrollment process for Medicare has not been updated for over 50 years when Medicare began. As a result 3/4 of a million Americans are paying a lifetime late enrollment penalty on their Medicare Part B premiums that is sometimes 30% or more of the current premium amount. In the past, most people who qualified for Social Security benefits at 65 years of age, were also then automatically enrolled into Medicare (as 65 is the general age of Medicare eligibility). Yet, now people born between 1948-1960 don’t qualify for full Social Security benefits until ages 66 to 67. (Full retirement age for people born in 1960 or later is 67). Also, more people are working longer and actively delaying the collection of their Social Security benefits. This means more and more people are no longer automatically enrolled in Medicare when turning 65. Yet, the federal government has no a formal notification system to let these people know about their Medicare eligibility, how and when to enroll and the financial consequences for not enrolling when first eligible.

The Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES) Act (S.3236 and H.R. 5772) simplifies the Part B enrollment process through reforms and required statutory changes. This is the culmination of several years of work in which California Health Advocates (CHA) and other national consumer groups have worked with the Centers for Medicare and Medicaid Services, sent numerous other sign-on letters, and discussed remedies for the disconnect between Social Security benefits and eligibility for Medicare and other enrollment problems. This legislation is the end result and we urge you to support its success.

Below is a summary of the BENES Act of 2016 by the Medicare Rights Center. Here is also a section-by-section summary of the Act (HR5772).



The laws underpinning Part B enrollment have not been revisited in over 50 years, since Medicare was first established. As a result, today nearly 750,000 Americans are paying a statutory lifetime late enrollment penalty, often 30% or more of their monthly Part B premium. Why? Because while people with Social Security benefits are automatically enrolled in Medicare, an increasing number of Americans are working longer, delaying retirement, and deferring Social Security. With fewer people automatically enrolled—and 10,000 Baby Boomers aging into Medicare each day—more people new to Medicare must actively enroll in Part B. Unfortunately, many such individuals fail to do so properly.

Different enrollment rules apply to those without coverage, with employer-based coverage, with retiree coverage, with COBRA coverage, and now with Marketplace coverage. The rules are so complicated that even the most sophisticated Human Resources (HR) departments struggle to follow them. Many retirees and people with disabilities who are paying for private coverage learn only after medical treatment that their insurance is “secondary” to Medicare and that relying on their insurance, instead of Part B, creates a “gap”—which can cost hundreds of thousands of dollars out-of-pocket.

Clear and simple advice to those approaching eligibility could help address the problem, but today the federal government provides no notification to people nearing Medicare eligibility that must actively enroll about when and how to do so. For those who make an honest mistake, an opaque process—known as equitable relief—requires them to prove they received erroneous advice from a federal official—a standard virtually impossible to meet. Championed by Congressmen Raul Ruiz (D-CA) and Patrick Meehan (R-PA) and Senators Bob Casey (D-PA) and Chuck Schumer (D-NY), the bipartisan, bicameral Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES) Act (S.3236 and H.R. 5772) modernizes and simplifies the Part B enrollment process through a series of reforms that require statutory changes.


Increases Notification and Education. The BENES Act will create a pathway for the Department of Health and Human Services (HHS), Social Security Administration (SSA), and Internal Revenue Service (IRS) to work together and notify individuals approaching eligibility about enrollment rules and how other insurance works with Medicare.

Eliminates Coverage Gaps during Enrollment Periods. The BENES Act guarantees that people with Medicare do not experience a break in critical coverage. Specifically, the bill will fix coverage gaps in the 5th, 6th a person’s Initial Enrollment Period (IEP) and in the General Enrollment Period (GEP).

Updates Avenues for Relief. Current law provides no standardized process for those seeking equitable relief for failing to enroll in Medicare. Many beneficiaries are obliged to pay a lifetime Part B premium penalty or experience gaps in coverage as a result of misinformation by a trusted source. Consequently, the BENES Act will make the criteria for equitable relief requests more flexible.


Here is a also letter of support from former Administrators of the Centers for Medicare & Medicaid Services/Health Care Financing Administration who are both Republicans and Democrats and who all agree on supporting the BENES Act.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.