Last Friday, Representatives Raul Ruiz (D-CA) and Pat Meehan (R-PA) introduced H.R. 5772, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act. The bill would address the need for better communication to newly eligible Medicare beneficiaries by requiring notices to individuals approaching eligibility on when and how they should enroll in coverage. NAHU has been advocating for better communication to newly eligible beneficiaries to avoid some of the complications from delayed enrollment, and we were able to include language in this bill to have health insurance agents and brokers to be among the stakeholders consulted on the notice development.
The legislation is intended to specifically address issues for people who are not receiving Social Security benefits and are thus not automatically enrolled in Medicare, which has been increasing in recent years as Americans work longer and defer Social Security past age 65. Many of these individuals are enrolled in various types of coverage, such as employer-based, retiree, COBRA or marketplace, and struggle with understanding Medicare’s complex enrollment rules. Often older adults and people with disabilities who are paying for private coverage learn only after medical treatment that their insurance is “secondary” to Medicare. Further, later enrollees in coverage may face increased healthcare costs and premiums, gaps in essential health coverage, and disruptions in access to needed care.
Individuals who fail to enroll in coverage according to the rules must pay a Part B late enrollment penalty, a nearly 30% increase in their monthly premium, of which roughly 750,000 Medicare beneficiaries paid in 2014. Currently individuals who fall into this situation and are seeking redress must prove that they received erroneous advice from a federal official. The bill addresses this problem by requiring federal agencies to send notices six months prior to an individual’s Initial Enrollment Period (IEP) and again one month prior to the IEP. It would also establish a one-stop website for enrollment content that covers both Medicare and Social Security.
The introduction of this legislation follows a letter NAHU signed onto earlier this month regarding the “Welcome to Medicare” packages. The letter included several recommendations directed at Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to help ensure that people new to Medicare avoid many of the problems associated with these honest Medicare enrollment mistakes. We specifically requested communication be included on when and how to enroll in coverage, placing a greater emphasis on coordination of benefits considerations, preserving content in multiple languages, creating standardized content based on the reason for Medicare eligibility, and using consistent branding and a uniform aesthetic on the “Welcome to Medicare” packages.