What is the BENES Act?

Many newly eligible Medicare beneficiaries are not automatically enrolled in Part B. If an individual misses the initial enrollment deadline, they could be subject to a permanent late enrollment penalty of as much as a 10% per month premium increase for each 12-month period they did not enroll in Part B. In 2018, approximately 760,000 Medicare enrollees paid the late enrollment penalty.

The House Health Subcommittee of the Energy and Commerce Committee debated the act in late January. During the hearing, Medicare Rights Center President Frederic Riccardi testified that confusing rules surrounding the enrollment process and the decoupling of Social Security and Medicare necessitate the enrollment outreach and assistance provided by the BENES Act.

Legislation

The BENES Act would improve enrollment education outreach to beneficiaries, reduce gaps in coverage and ease the enrollment process.

The act creates a notice for individuals between the ages of 60 and 64 that outlines their Medicare Part B eligibility and explains the possibility of late enrollment penalties. The notice is to be posted on the websites of Social Security, the Centers for Medicare & Medicaid Services, and the Department of Health and Human Services. It is also mailed to individuals at least twice in the three months prior to their enrollment period at age 65. 

Crafting the Notice  

According to the bill, the secretary of the Department Health and Human Services and the commissioner of Social Security should consult with individuals in the following groups to craft the notice:

• Individuals over 60 
• Veterans
• People with disabilities
• Individuals with end-stage renal disease
• Low-income individuals and families
• Employers 
• States (including representatives of state-run health insurance exchanges, Medicaid offices, and state insurance departments)
• State health insurance assistance programs
• Health insurers
• Health insurance agents and brokers
• Such other groups as specified by the secretary

Did You Know?

The Part B penalty is 10% of the monthly premium for each 12 months a beneficiary fails to enroll after the Initial Enrollment Period ends. This penalty must be paid every month, unless certain conditions are met that allow a beneficiary to sign up under a special enrollment period.

What Happens Next?

Further legislative action is still necessary for the bill to become law. The full Energy and Commerce Committee will need to take additional steps through a committee mark-up, followed by consideration by the full House of Representatives. A similar process will need to take place in the Senate, with the Senate Finance Committee holding jurisdiction over the legislation. The National Association for Home Care & Hospice has endorsed the bill.

Track this bill at congress.gov.