The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act
In December 2020, key provisions of the BENES Act were signed into law as part of a comprehensive legislative package. The enacted policies will update Medicare enrollment rules for the first time in over 50 years to end lengthy waits for coverage, expand critical administrative flexibilities, and inform future policymaking on enrollment period alignment. These changes take effect in 2023.
To ensure these policies are adopted in a thoughtful and timely manner, the Medicare Rights Center urges the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to immediately begin a transparent implementation process that engages stakeholders and advances health equity goals.
The Streamlining Part D Appeals Process Act
The Medicare Part D appeals process is an essential safety valve that allows older adults and people with disabilities to obtain needed medications. However, the current process is overly onerous and deeply flawed. Its inefficiencies can lead to delays in beneficiary access, abandonment of therapies, reduced adherence to treatment protocols, worse health outcomes, and higher costs.
The bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924), supported by Medicare Rights, offers a commonsense solution: allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination. This one, simple change would give people with Medicare more timely information about their plan’s coverage decision and eliminate unnecessary steps within the system.
Improve Medicare Plan Finder
In the fall of 2019, the Centers for Medicare & Medicaid Services (CMS) unveiled significant updates to Medicare Plan Finder, the federal government’s primary enrollment assistance tool. The revised website includes a number of important changes that Medicare Rights has long supported, such as a streamlined design and a more intuitive presentation.
Based on our experience assisting people with Medicare and their families during Fall Open Enrollment and throughout the year, we know how challenging it can be for older adults and people with disabilities to evaluate their health care and prescription drug coverage options. Accordingly, while we appreciate CMS’s efforts to modernize Medicare Plan Finder, we are troubled by initial and persistent inaccuracies on the site that may undermine beneficiary decision-making.
To improve the tool’s functionality, Medicare Rights has provided feedback to CMS regarding opportunities to further strengthen this important resource. While some of our recommendations have been adopted, others remain unaddressed. Looking ahead, we will continue to encourage CMS to correct problems with the updated platform and enhance the user experience, so that people with Medicare have access to the accurate, actionable, and personalized information they need to make optimal coverage decisions.
Learn more about Medicare Rights’ observations and recommendations:
Make Prescription Drugs More Affordable
Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs both for people with Medicare and for the program as a whole. Important strategies include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing pricing transparency and accountability throughout the supply chain. Changes to the current system must not undermine beneficiary protections or access to care.
In December 2019, the House of Representatives passed landmark prescription drug legislation, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). Medicare Rights is pleased to support this important bill, which would significantly improve health care and prescription drug affordability for people with Medicare. Work in the Senate is currently underway to craft a comprehensive drug pricing package.
Learn more about some of the Drug Pricing and Part D reforms the Medicare Rights Center supports:
Reduce Barriers to Medicare Low-Income Assistance Programs
Medicare Savings Programs and Part D’s Low-Income Subsidy (LIS) or “Extra Help”—can make care, including prescription drugs, more affordable for older adults and people with disabilities, but the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.
Medicare Rights continues to urge lawmakers to modernize these policies to better reflect beneficiary financial realities, and to incorporate reforms made elsewhere in the health care system. This includes eliminating the asset limits for Medicare low-income assistance programs; allowing more people to access the benefits; aligning eligibility thresholds across programs; as well as integrating and simplifying administrative functions.
Learn more by reading Medicare Rights’ fact sheet.
Improving Access to Care for People with Medicare and Medicaid
There are currently more than 12 million Americans enrolled in both Medicare and Medicaid. These individuals, called dual-eligibles, experience high rates of chronic illness and represent a disproportionate share of national health care spending. As such, the federal government and states frequently consider and implement programs aimed at improving health care for dual-eligibles while reducing the costs associated with that care.
Medicare Rights devotes significant energy to monitoring programs intended to serve people with Medicare and Medicaid. Nationally, we work in partnership to amplify the voices of dual-eligibles and help ensure that new programs work for this population. In New York, we lead the Coalition to Protect the Rights of New York’s Dually Eligible and engage regularly with state government and other stakeholders to shape and implement new programs, such as those intended to integrate coverage and care across Medicare and Medicaid.
Medicare Rights also pursues casework solutions for our dual-eligible clients, helping them access home health care, medicines, therapies, behavioral health services, and more.