The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act

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The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act is a bipartisan bill that was signed into law. BENES makes changes to the federal health program, which had not seen modifications in decades. Below, we explain what BENES entails and how it benefits those who are Medicare-eligible.

What is the BENES Act?

The BENES Act, which stands for Beneficiary Enrollment Notification and Eligibility Simplication, became law in late 2020 but goes into effect in 2023. It includes provisions that will make the process of enrolling in Medicare easier for beneficiaries to understand. Additionally, it extends the timeframe for Medicare coverage for some beneficiaries eligible due to End-Stage Renal Disease.

Some of the primary components of the BENES Act include:

  • Elimination of seven-month waiting period beneficiaries can encounter after enrolling during the General Enrollment Period
  • Adds a provision for a Special Enrollment Period in Advantage and Part D prescription drug plans due to exceptional circumstances, which allows for more flexibility and increased access to care
  • Future alignment of enrollment periods to reduce confusion

Who Supports the BENES Act?

The BENES Act was introduced by eight former Medicare program administrators. The Act has support from politicians on both sides of the aisle. Additionally, support comes from organizations that represent older Americans and people with disabilities, including insurance carriers.

How Does the BENES Act Work?

The BENES Act will go into effect in 2023. Then, the following updates will come to Medicare:

  • For beneficiaries signing up during the General Enrollment Period, coverage will begin the first day of the following month (instead of July 1 for every person utilizing this enrollment period)
  • Beneficiaries who sign up during their Initial Enrollment Period but in one of the months following their 65th birthday will have their Medicare become effective on the first day of the month after they sign up
  • A Special Enrollment Period for Part B that will allow coverage to start on the first day of the month following enrollment
  • Outreach from the Centers for Medicare & Medicaid Services to inform and educate soon-to-be eligible individuals about enrollment
  • Extension of Medicare coverage for ESRD patients under age 65 if they otherwise lack health insurance

Helping People Transition to Medicare

Medicare involves many components and can seem opaque at times. Consequently, many people who age into Medicare find the program confusing. Thus, the purpose of the BENES Act is to simplify certain aspects of Medicare so beneficiaries can transition to their new health care with increased ease. Additionally, it will help more Americans with failing kidneys obtain affordable health care.

Often, when individuals reach Medicare age and don’t have a proper understanding of its rules, they encounter financial penalties due to gaps in coverage. When the BENES Act is in effect, people will receive advance notice for their Medicare eligibility. This will be a game-changer and prevent many people from incurring penalties that they would otherwise need to pay indefinitely.

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