A Simple Solution To Medicare’s Enrollment Mess

Enrolling in Medicare Part B should be simple. But for years the government has been making enrollment nearly impossible for millions of seniors, especially those who are still working or who have delayed taking their Social Security benefits. They are never told that are eligible for Medicare, they don’t know that they face still penalties if they don’t enroll by a deadline, and they can’t figure out how Medicare fits with other health insurance they may have.

Finally, bipartisan bills in the House and Senate would take steps to the fix the problem. People about to turn 65 would get a notice clearly explaining Part B’s enrollment rules and the Medicare enrollment period would become aligned with those of other insurance programs. The Department of Health and Human Services, the Social Security Administration, and the IRS would be able to work together to explain Medicare to those becoming eligible.

A bipartisan fix

The identical House and Senate measures are called the Benefit Enrollment Notification and Eligibility Simplification (BENES) Act.  They are sponsored by senators Todd Young (R-IN) and Bob Casey (D-PA) and in the House by Reps. Raul Ruiz (D-CA) and Patrick Meehan (R-PA).

Medicare has its many parts, which is confusing enough. There is no premium for Part A, which covers hospital care. You must enroll and begin paying premiums for Part B, which includes physician and outpatient care.  If you don’t enroll within a short window after you are first eligible, you owe a stiff penalty—10 percent of your premium for each year you delay. Here is a good, but slightly wonky, explanation of how it all works.

Back in the day, this was all pretty simple. You turned 65, retired from your job, got your gold watch, and started taking Social Security.  Once  you sign up for Social Security benefits, you get a Medicare card and a “Welcome to Medicare” package about three months before your 65th birthday. You are automatically enrolled in both Part A and Part B on the first day of the month you turn 65. Nice and easy.

Not so simple for the Boomers

But for many Baby Boomers, the full Social Security enrollment age is now 66 or later. And what if you choose to delay taking Social Security until you are 70, which is a wise choice for many and encouraged by the government? IF you are not get Social Security benefits, you get no information from Medicare. No notice that you are eligible. No warning about the late enrollment penalties. No “Welcome to Medicare.” You must know the rules and take the initiative to enroll.

What if you are still getting insurance from your employer? Or getting COBRA from your former employer? Or have bought insurance on the Affordable Care Act health exchanges. How does Part B fit with that coverage and how do you synch the loss of that private insurance with Part B? What if your private insurance ends before Medicare’s annual enrollment period begins. Well, says the government, “figure it out. It isn’t our problem.”

Severe consequences

The consequences for older Americans can be severe. The Congressional Research Service estimates that in 2014, 750,000 people paid a late enrollment penalty that averaged 30 percent. Others fell through the cracks between private insurance and Medicare, never realizing they had no coverage at all until they got a bill.

The Trump Administration would make the Medicare enrollment process even harder by proposing to shutter a small federal program, called the State Health Insurance Program (SHIP), that helps seniors navigate Medicare.

I wrote about the Medicare enrollment mess more than two years ago. A bill was introduced in 2016, but went nowhere. Now, perhaps, Congress is starting to pay attention. And the bill has generated broad support from consumer and provider groups, led by the Medicare Rights Center. That group, which gives individual advice about Medicare, says that about one-quarter of the 3 million calls it got in 2016 were from people who did not understand the enrollment process.

This should be a no-brainer. Medicare is a critical government insurance program that its beneficiaries don’t understand. It shouldn’t take an act of Congress to get the government to explain it. But since it apparently does, Congress should pass BENES and fix the problem.

 

 

 

 

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