How the BENES Act Impacts Medicare - United Benefits

What is the BENES Act?

The Beneficiary Enrollment Notification and Eligibility Simplification Act, also known as the BENES Act, was designed to help those who are Medicare eligible but are not collecting social security. The BENES Act was signed into law in 2020 and will become effective in 2023. It was created to ensure that Americans approaching Medicare eligibility receive all of the necessary information about Medicare so they can avoid mistakes and penalties when enrolling. It also aligns the annual and general enrollment periods so you don’t go months without coverage if you make a mistake. In addition, it creates a Special Enrollment Period (SEP) for extreme circumstances that may have affected your ability to enroll in Medicare.

When do I enroll in Medicare?

For most people, their Full Retirement Age is older than 65. This means that many people are eligible for Medicare but not taking Social Security because they are waiting for their Full Retirement Age. If you are not receiving social security benefits, you will need to take action to enroll in Medicare. It doesn’t happen automatically. You will need to contact Social Security or apply for Medicare on Social Security’s website. You can apply during your Initial Enrollment Period (IEP) which is a seven-month window that starts three months before your 65th birthday, the month of your birthday, and the three months following your 65th birthday. If you do not apply for Medicare during this time period, you may incur penalties for Part B and Part D coverage. Keep in mind that if you are actively working and have credible group coverage, you can delay enrolling in Medicare Part B and D until you retire or otherwise lose credible coverage.

Primary Components of the BENES Act

Some of the primary components of the BENES Act include:

  • Elimination of the seven-month waiting period if enrolling during the General Enrollment Period, which is January 1 – March 31. If you miss your IEP and do not have a special enrollment, such as losing group coverage or retiring, you will have to apply for Medicare during this time period. Prior to the BENES Act, your Medicare coverage would not begin until July 1. The BENES Act requires that your Medicare coverage will start the first of the month after you apply.
  • Additionally, if you sign up during your IEP but after your 65th birthday, your Medicare coverage will start on the first day of the month after your application is submitted.
  • The BENES Act also adds a provision for a Special Enrollment Period in Medicare Advantage and Part D prescription drug plans due to exceptional circumstances, which allows for more flexibility and increased access to care.
  • The BENES Act also extended additional coverage to beneficiaries with ESRD if they lack other health insurance.

Have Questions About the BENES Act?

If you have questions about the BENES Act, how to enroll in Medicare coverage, or any other questions about Medicare, you can contact a United Benefits Medicare Specialist by filling out the form below.

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