BENES Act of 2019

To amend title XVIII of the Social Security Act to establish a system to notify individuals approaching Medicare eligibility, to simplify and modernize the eligibility enrollment process, and for other purposes. 1. Short title This Act may be cited as the Beneficiary Enrollment Notification and Eligibility Simplification Act of 2019 BENES Act of 2019 2. Beneficiary Enrollment Notification and Eligibility Simplification (a) Eligibility and enrollment notices (1) As part of social security account statement for individuals age 60 to 65 Section 1143(a) of the Social Security Act ( 42 U.S.C. 1320b–13(a) (4) Medicare eligibility information (A) In general In the case of statements provided on or after the date that is 2 years after the date of the enactment of this Act to individuals who have attained 60 years of age but have not attained 65 years of age, the statement shall also include a notice containing the information described in subparagraph (B). (B) Contents of Notice The notice required under subparagraph (A) shall contain information on (including a clear, simple explanation of)— (i) eligibility for benefits under the Medicare program under title XVIII, and in particular benefits under part B of such title; (ii) the possibility of a late enrollment penalty for failure to timely enroll (including the process for requesting relief under section 1837(h) in plain language); (iii) the need for coordination of benefits under such part B (including primary and secondary coverage scenarios) imposed under title XVIII; and (iv) populations, such as veterans, for whom there are special considerations with respect to enrollment under this title. (C) Development of notice (i) In general The Secretary, in consultation with representatives of each of the groups described in subparagraph (D)(i), and in coordination with the Commissioner of Social Security, shall develop the notice to be provided pursuant to subparagraph (A). (ii) Notice improvement The Secretary, not less than once every two years, shall— (I) review the content of the notice to be provided under subparagraph (A); and (II) update and revise such notice as the Secretary deems appropriate. (D) Groups for consultation (i) In general For purposes of subparagraph (C), the groups described in this clause include the following: (I) Individuals who are more than 60 years of age. (II) Veterans. (III) Individuals with disabilities. (IV) Individuals with end stage renal disease. (V) Low-income individuals and families. (VI) Employers (including human resources professionals). (VII) States (including representatives of State-run Health Insurance Exchanges, Medicaid offices, and Departments of Insurance). (VIII) State Health Insurance Assistance Programs. (IX) Health insurers. (X) Health insurance agents and brokers. (XI) Such other groups as specified by the Secretary. (ii) Nonapplication of FACA The Federal Advisory Committee Act shall not apply to consultations made pursuant to subparagraph (C) with groups described in clause (i). (E) Posting of notice on websites The Commissioner of Social Security and the Secretary shall each ensure that the notice being used under subparagraph (A) is posted in a prominent location on their respective Department Internet website. . (2) Individuals in Medicare waiting period Title XI of the Social Security Act is amended by inserting after section 1144 the following new section: 1144A. Medicare enrollment notification and eligibility notices for individuals in Medicare waiting period (a) Notices (1) In general The Commissioner of Social Security, in coordination with the Secretary, shall distribute the notice developed and used by the Commissioner under section 1143(a)(4) to individuals in the Medicare waiting period under section 226(b) of this Act. (2) Authority to modify notice The Secretary, in coordination with the Commissioner of Social Security, may modify the notice to be distributed under paragraph (1) as necessary to take into account the population receiving the notice. (3) Posting of notice on websites The Commissioner of Social Security and the Secretary shall each ensure that the notice being distributed under paragraph (1) is posted in a prominent location on their respective Department Internet website. (b) Timing Beginning two years after the date of the enactment of this section, a notice required under subsection (a)(1) shall be mailed to an individual no less than two times in accordance with the following: (1) The notice shall be provided to such individual no later than 3 months prior to the date of such individual’s enrollment period as provided under section 1837. (2) The notice shall subsequently be provided to such individual no later than one month prior to such date. . (b) Beneficiary Medicare part B enrollment periods and effective date of coverage (1) Effective dates Section 1838(a) of the Social Security Act ( 42 U.S.C. 1395q(a) (A) by amending paragraph (2) to read as follows: (2) (A) in the case of an individual who enrolls pursuant to subsection (d) of section 1837 before the month in which he first satisfies paragraph (1) or (2) of section 1836, the first day of such month, (B) in the case of an individual not described in subparagraph (A) who first satisfies such paragraph in a month beginning before January 2021 and who enrolls— (i) pursuant to such subsection (d) in such month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls, (ii) pursuant to such subsection (d) in the month following such month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or (iii) pursuant to such subsection (d) more than one month following such month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls, (C) in the case of an individual not described in subparagraph (A) who first satisfies such paragraph in a month beginning on or after January 1, 2021, and who enrolls pursuant to such subsection (d) in such month in which he first satisfies such paragraph or in any subsequent month of his initial enrollment period, the first day of the month following the month in which he so enrolls, (D) in the case of an individual not described in subparagraph (A) who enrolls pursuant to subsection (e) of section 1837 in a month beginning before October 15, 2020, the July 1 following the month in which he so enrolls, or (E) in the case of an individual not described in subparagraph (A) who enrolls pursuant to subsection (e) of section 1837 in a month beginning on or after October 15, 2020, the first day of the month following the month in which he so enrolls. ; and (B) by amending paragraph (3) to read as follows: (3) (A) in the case of an individual who is deemed to have enrolled on or before the last day of the third month of his initial enrollment period, the first day of the month in which he first meets the applicable requirements of section 1836 or July 1, 1973, whichever is later, (B) in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period beginning before January 1, 2021, as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and (D) of paragraph (2) of this subsection, or (C) in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period beginning on or after January 1, 2021, as prescribed under paragraph (2)(C) of this subsection. . (2) General and special enrollment periods Section 1837(e) of the Social Security Act ( 42 U.S.C. 1395p(e) (e) Enrollment Periods (1) For coverage during years before 2022 There shall be a general enrollment period during the period beginning on January 1 and ending on March 31 of each year before 2022. (2) For coverage during years beginning with 2022 For coverage during years beginning with 2022 and each subsequent year, there shall be a general enrollment period beginning on October 15 of the previous year through December 31 of such previous year. (3) Exceptional Circumstances The Secretary may establish a special enrollment period in the case that an individual meets such exceptional conditions as the Secretary may provide. . (3) Technical correction (A) In general Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) close of the enrollment period close of the month (B) Effective date The amendment made by subparagraph (A) shall take effect on November 1, 2021.

Summary: Beneficiary Enrollment Notification and Eligibility Simplification Act of 2019 or the BENES Act of 2019 This bill makes a series of changes to, and requires additional notifications regarding, the Medicare enrollment process. Specifically, the bill changes the Medicare general enrollment period to October 15-December 31, and requires coverage to begin on the first day of the month following enrollment. (Currently, the general enrollment period is January 1-March 31, and coverage begins July 1.) The bill also generally requires coverage to begin on the first day of the month following enrollment for individuals who enroll in the latter months of their initial enrollment period. (Currently, the longer an individual waits to enroll, the more delayed the effective date of coverage.) The bill also requires Social Security account statements for individuals ages 60 to 64 to include information about Medicare eligibility, late enrollment penalties, coordination of benefits, and special enrollment populations (e.g., veterans).