Benes Act 2020

A House committee unanimously approved legislation Wednesday that would make changes for the first time in 50 years to the complex rules for enrolling in Medicare’s Part B, which covers doctor visits and other outpatient care.

Currently, seniors who don’t get Part B when they first become eligible for Medicare pay permanent, recurring late enrollment penalties and can only sign up during the first 3 months of the year for coverage that begins July 1, unless they qualify for an exception. To make matters worse, they cannot buy other health insurance during their months-long wait.

Patients often find out they need Part B only after their provider or insurance company sends them a bill for services. That’s because only Social Security beneficiaries currently receive a notice when they become eligible for Medicare.

If the measure, known as the “BENES” Act (Beneficiary Enrollment Notification and Eligibility Simplification Act), becomes law, the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration would be required to notify people before they turn 63, 64, and 65 that they may be eligible for Medicare at age 65. It would eliminate the waiting period by ensuring that coverage begins on the first of the month after they sign up.

In a letter to committee leadership, the American Medical Association joined 105 patient advocacy and provider groups, health insurer associations and unions to urge support for the bill.

“Currently, far too many people make honest mistakes when trying to understand and navigate this confusing system,” they wrote. “The consequences of such missteps are significant — including late enrollment penalties, higher out-of-pocket health care costs, gaps in coverage, and barriers to accessing needed service.” In 2019, 764,000 Medicare beneficiaries paid a penalty for late Part B enrollment, increasing their monthly premiums by an average 28%, according to a May report by the Congressional Research Service.
Last week, 10 former administrators of CMS spanning the past four decades wrote to Senate and House leaders in support of the bill.

The House of Representatives is expected to pass the bill sometime this year but its prospects in the Senate are still uncertain.

“Passage of the BENES Act will not only help people who are eligible for Medicare but will be welcomed by health care providers, too.” said Fred Riccardi, president of the Medicare Rights Center, a national, nonprofit consumer service organization which is leading the campaign to pass the bill. “Once the Part B enrollment process is modernized and simplified to ensure timely access to Medicare and eliminate gaps in consumers’ coverage and disruptions in their continuity of care, it will be a win-win for both consumers and providers.”

The committee also approved several other health-related legislation, including measures that would:

Extend Medicare coverage for immunosuppressant drugs for kidney transplant recipients under the age of 65 beyond the current 36 months provide mental health telehealth coverage under Medicare; and Prevent and treat mental health problems among public safety officers and frontline health care providers following the coronavirus response.

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