Signed into law in December 2020, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act updated Medicare enrollment rules for the first time in over 50 years. Its key provisions went into effect in January 2023, ending long waiting periods for coverage and expanding critical administrative flexibilities to grant Special Enrollment Periods (SEPs).
How does the BENES Act affect Medicare beneficiaries?
The primary components of the BENES Act that affect Medicare beneficiaries are:
Reduction of the waiting period beneficiaries had before their Medicare coverage kicked in after enrolling in the later months of their Initial Enrollment Period (IEP).
Elimination of the seven-month waiting period beneficiaries had before getting their Medicare coverage after enrolling during the General Enrollment Period (GEP).
Adding a provision for Medicare to grant “Special Enrollment Periods” for “exceptional circumstances”, similar to the flexibilities Medicare Advantage and Part D plans already enjoy. This will help make it easier for beneficiaries to enroll in the program, and enhance administrative consistency.
How will the BENES Act work?
Initial Enrollment Period
The Initial Enrollment Period is the seven-month window when seniors first become eligible to enroll in Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drug coverage). Note: seniors who have already taken Social Security benefits before age 65 will be automatically enrolled in Part A when they turn 65. The IEP begins three months before the month of the individual’s 65 birthday and ends at the end of the third month following this birthday. Starting in 2023, coverage will take effect the first day of the following month, regardless of which month they sign up during their IEP. In the past, if you enrolled during the first three months of the IEP, coverage didn’t begin until the first day of the fourth month. If you enrolled during the fourth month of the IEP or any of the three months afterwards, coverage would begin the first day of the month following the month of enrollment.
General Enrollment Period
The Medicare General Enrollment Period is for seniors who missed their Initial Enrollment Period to sign up for Medicare benefits. The GEP runs each year between January 1 and March 31 each year. Until this year, seniors who signed up during GEP would need to wait seven months for coverage to kick in on July 1 but now coverage will begin the first day of the following month after enrollment.
Special Enrollment Periods
There are various reasons that an individual may qualify for a Special Enrollment Period (SEP) to sign up for Medicare Part B. One of the most common reasons for an SEP is when Part B enrollment was delayed because the individual still had private health insurance through their employer but special life circumstances are also qualifying. Starting this year, individuals may be eligible to sign up outside of current enrollment periods if they have “exceptional circumstances” that occur on or after January 1, 2023. You will need to contact Social Security to get approval for an exceptional circumstance.
Here are the exceptional circumstances:
1. If you missed an enrollment opportunity because you or the person who makes health care decisions on your behalf live in an area where the Federal, state, or local government declared an emergency, your SEP begins the date the emergency or disaster is declared and ends six months after the end date in the emergency declaration. Your coverage begins on the first of the month after the month you enroll.
2. If your employer, employer health insurance plan, or someone acting on behalf of your employer gave you incorrect information that caused you to delay Medicare enrollment, your SEP begins the day you notify Social Security of the misinformation and ends six months after you notify Social Security. Your coverage begins on the first of the month after the month you enroll.
3. If you are released from incarceration, your SEP begins the day you are released from incarceration and ends the last day of the twelfth month after you are released. You can choose to have your coverage begin on the first of the following month after you enroll or you set it to start up to six months retroactively.
4. If you lose Medicaid eligibility, your SEP begins when you receive notice of upcoming termination of Medicaid eligibility and ends six months after the termination of eligibility. You can choose to have your coverage begin on the first of the following month after you enroll or have your coverage begin retroactively back to when your Medicaid ended.
5. If Social Security decides that you have experienced an exceptional circumstance, you may be granted a SEP. The length of the SEP and coverage start will be determined by the Social Security Administration.
As Medicare agents, we are happy to see Medicare beneficiaries gain access to their Medicare benefits sooner. If you have any questions about signing up for Medicare, please give us a call.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. We are the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan, which means we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.