Medicare Rights Supports BENES Act Implementation Rules

This week, Medicare Rights submitted comments in response to a proposed rule that would implement elements of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act signed into law as part of the Consolidated Appropriations Act, 2021  (CAA) in December 2020. These elements would improve access to Medicare benefits, reduce delays and gaps in coverage, provide essential relief for some who make honest enrollment mistakes, and allow the Centers for Medicare & Medicaid Services (CMS) to ease enrollment for people who may face exceptional circumstances in the future. The rule would also implement new benefits for people who have lost Medicare coverage after a kidney transplant and modernize systems for state payments of Medicare premiums.

Specifically, the proposed rule would implement the BENES Act’s elimination of the months-long wait for coverage that people currently experience when they sign up for Medicare during the General Enrollment Period or the later months of their Initial Enrollment Period. It would also create Special Enrollment Periods (SEPs) for certain individuals, including those losing Medicaid coverage or leaving incarceration, and those whose enrollment errors are due to misinformation from an employer or group health plan, to prevent gaps in coverage or punitive late enrollment penalties. Each of these changes are long-awaited, and our comments strongly support CMS finalizing these proposals. We also urge the agency to make several adjustments to ensure the SEPs are consistent with the stated aims of the proposed rule—to increase coverage, decrease health inequity, and minimize disruptions in care and coverage.  

The rule would also implement the creation of a new Medicare benefit to provide continued coverage for immunosuppressive medications for people who had Medicare at the time of their kidney transplant, but whose coverage under Medicare has since terminated, and who do not have comprehensive health insurance through Medicare or other sources. As noted in the proposed rule, adequate education and information is essential so that people who avail themselves of this limited coverage understand that, unlike all other Parts of Medicare, this is not comprehensive health insurance and will not cover care outside of the narrow scope of immunosuppressive treatments.

CMS also proposes to update and centralize the rules that govern the way states pay Medicare premiums for people with low incomes. CMS does not anticipate these changes to have any impact on the operation of these programs, as the modifications largely alter existing language to more accurately reflect current practices. Ensuring that the rules plainly reflect current practice not only reduces opportunity for confusion but may also increase the likelihood that states take up expansions to these programs.

At Medicare Rights, we are excited that many of these much-needed Medicare improvements will finally be implemented. We hope CMS will take our suggestions into account as they move forward with this rule. We also will continue to work with Congress to further simplify Medicare enrollment through passage of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) 2.0 Act (S. 3675), which would build upon the original BENES Act by promoting informed enrollment choices.  

Read our comments.