Key BENES Act Provisions Signed into Law

On December 23, Congress passed several key provisions of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) as part of a comprehensive legislative package. Signed into law days later, these policies will update Medicare enrollment rules for the first time in over 50 years to end lengthy waits for coverage, expand critical administrative flexibilities, and inform future policymaking on enrollment period alignment.

The bipartisan BENES Act was introduced in the 116th Congress by Senators Bob Casey (D-PA) and Todd Young (R-IN) and by Representatives Raul Ruiz (D-CA), Gus Bilirakis (R-FL), Brad Schneider (D-IL), and Jackie Walorski (R-IN).

In applauding passage, Medicare Rights Center President Fred Riccardi issued the following statement:

“Thanks to the BENES Act’s congressional champions—Senators Casey and Young and Representatives Ruiz, Bilirakis, Schneider, and Walorski—as well as House and Senate leadership, the committees of jurisdiction, and dedicated congressional staffers, millions of Americans will be able to avoid enrollment pitfalls of the current system and more easily connect with their earned Medicare benefits. We are profoundly grateful to our pro bono partners at King & Spalding, along with the bill’s many stakeholders and supporters, for their efforts to advance these lasting and vital Medicare improvements.”

The adopted BENES Act policies will modernize Medicare enrollment in several important ways:

• The bill eliminates the up to seven month-long wait for coverage that people can experience when they sign up for Medicare during the General Enrollment Period (GEP) or in the later months of their Initial Enrollment Period (IEP). Beginning in 2023, Medicare coverage will begin the month after enrollment.
• It reduces barriers to care by expanding Medicare’s authority to grant a Special Enrollment Period (SEP) for “exceptional circumstances.” A long-standing flexibility within Medicare Advantage and Part D, in 2023 this critical tool will be available to facilitate enrollments program-wide, enhancing beneficiary access and administrative consistency.
• To further maximize coverage continuity and ease transitions to Medicare, the bill directs the U.S. Department of Health and Human Services (HHS) to identify ways to align Medicare’s annual enrollment periods. HHS is to present these findings in a report to Congress by January 1, 2023.

In addition to these changes, the wide-ranging legislation funds the federal government through the end of the current fiscal year, provides some COVID-19 relief, and renews important health care policies for three years. The extensions include funding for community-based organizations that provide outreach and enrollment to low-income Medicare beneficiaries, financial protections for people whose spouses are on Medicaid and in a nursing home or long-term care facility, and Medicaid’s Money Follows the Person program, which supports individuals who wish to leave nursing facilities and return to their homes. Medicare Rights supports investment in these and other initiatives that help older adults and people with disabilities live with health and dignity. We look forward to further advancing these goals in 2021.

Read the legislation.