Unraveling the mystery of the BENES Act Provision
On Dec. 23, 2020, Congress passed a new provision called the Beneficiary Enrollment Notification and Eligibility Simplification Act of 2020, or “BENES Act” of 2020 as part of the $900 billion pandemic aid package. This bill had wide bipartisan support in the House of Representatives and the Senate. The bill also had strong support from more than 85 national and state organizations that support older adults and people with disabilities.
The BENES Act is the first update to Original Medicare (Medicare Part A hospital coverage, and Part B medical coverage) since it was signed into law in 1965 by President Lyndon B. Johnson. The intent of this legislation is to modernize and make improvements to Medicare that will benefit the individuals just becoming eligible for Medicare, those who have been eligible for Medicare but have not enrolled, and those who already have Medicare. It will provide cost savings to some who enroll in the annual General Enrollment Period (GEP) by eliminating or decreasing possible late enrollment penalties as well as giving access to coverage without delay for both those who enroll in the GEP and the last three months of the Initial Enrollment Period (IEP).
Under this provision, coverage for Part B will begin the first day of the month following enrollment, thereby eliminating delays in accessing the insurance benefits. This will also allow beneficiaries to purchase Medicare Supplement plans under the Open Enrollment period sooner, which will provide more complete coverage.
Although passed by Congress on Dec. 23, 2020 and signed into law the last week of December 2020, these provisions will not become effective until Jan. 1, 2023.
Note that these are federal changes, so all people with Medicare are affected whether they have Original Medicare or choose a Medicare Advantage (MA) plan. (It is important to note that MA plans are not available to the general public in Alaska.)
The goal of this legislation is to make sure that individuals know when Medicare is available to them, to aid in making enrollment in Medicare simpler and more clear-cut, and to lower the costs related to late enrollment penalties.
Here are some of the provisions included in the bill.
Decreasing the wait time for Medicare Part B coverage to become effective when enrolling in the GEP or the last three months of the IEP. Currently, the wait time can be up to three months for the IEP and six months for the GEP.
Providing notifications of upcoming eligibility for Medicare. The Social Security Administration (SSA) will provide advance notice to persons approaching eligibility about when to enroll and basic enrollment rules and options. This will appear in the annual letter that SSA sends out to people when they are turning 63, 64 and 65 concerning their retirement benefits. Individuals who are becoming eligible for Medicare due to receiving Social Security Disability benefits will be alerted as well by being sent a notice twice around the end of their waiting period for Medicare. A notice will be posted on the Social Security website. SSA will be reimbursed by Center for Medicare and Medicaid Services (CMS) for these outreach efforts.
Expands Medicare’s authority to grant a Special Enrollment Period for “exceptional circumstances”. This flexibility is already available for Part D and Medicare Advantage plans. This will allow Original Medicare to facilitate enrollments that will increase beneficiary access, promote administrative consistency and keep beneficiaries costs down. This means that if you miss your enrollment period, you can request a Special Enrollment Period.
Charges the U.S. Department of Health and Human Services (HHS) to identify ways to align Medicare’s annual enrollment periods. Currently there are three different annual enrollment periods: Parts A and B from Jan. 1 through March 31; Part D from Oct. 15 to Dec. 7; and Part C from Jan. 1 to March 31. HHS will be responsible to present a report to Congress by Jan. 1, 2023, on the strategy for aligning these enrollment periods and lessen confusion for beneficiaries.
Although these changes will not become effective until January 2023, they are welcome improvements to the very complex and confusing process of Medicare enrollment. If you have questions about the BENES Act of 2020 or about your Medicare eligibility, coverage or costs, please contact the Medicare Information Office toll-free statewide at 1-800-478-6065 or visit the State of Alaska Medicare Information Office website at http://www.medicare.alaska.gov.
Nila Morgan is a Certified Medicare Counselor who works at the Anchorage Senior Activity Center.
