Sec. 101. Beneficiary enrollment notification and eligibility simplification
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Section 1143(a) of the Social Security Act ( 42 U.S.C. 1320b–13(a) ) is amended by adding at the end the following new paragraph: In the case of statements provided on or after the date that is 2 years after the date of the enactment of this paragraph to individuals who are attaining ages 63, 64, and 65, the statement shall also include a notice containing the information described in subparagraph (B). The notice required under subparagraph
(A)shall include a clear, simple explanation of— eligibility for benefits under the Medicare program under title XVIII, and in particular benefits under part B of such title; the reasons a late enrollment penalty for failure to timely enroll could be assessed and how such late enrollment penalty is calculated, in particular for benefits under part B; the availability of relief from the late enrollment penalty and retroactive enrollment under section 1837(h) (including as such section is applied under sections 1818(c) and 1818A(c)(3)), with examples of circumstances under which such relief may be granted and examples of circumstances under which such relief would not be granted; coordination of benefits (including primary and secondary coverage scenarios) pursuant to section 1862(b), in particular for benefits under part B of such title; and information for populations, such as residents of Puerto Rico and veterans, for whom there are special considerations with respect to enrollment, eligibility, and coordination of benefits under title XVIII. The Secretary, in coordination with the Commissioner of Social Security, and taking into consideration information collected pursuant to clause (ii), shall, not later than 12 months after the last day of the period for the request of information described in clause (ii), develop the notice to be provided pursuant to subparagraph (A). Not later than 6 months after the date of the enactment of this paragraph, the Secretary shall request written information, including recommendations, from stakeholders (including the groups described in subparagraph (D)) on the information to be included in the notice. Beginning 4 years after the date of enactment of this paragraph, and not less than once every two years thereafter, the Secretary, in coordination with the Commissioner of Social Security, shall— review the content of the notice to be provided under subparagraph (A); solicit recommendations on the notice through a request for information process as described in clause (ii); and update and revise such notice as the Secretary deems appropriate. For purposes of subparagraph (C)(ii), the groups described in this clause include the following: Individuals who are 60 years of age or older. Veterans. Individuals with disabilities. Individuals with end stage renal disease. Low-income individuals and families. Employers (including human resources professionals). States (including representatives of State-run Health Insurance Exchanges, Medicaid offices, and Departments of Insurance). State Health Insurance Assistance Programs. Health insurers. Health insurance agents and brokers. Such other groups as specified by the Secretary. The Commissioner of Social Security and the Secretary shall post the notice required under subparagraph
(A)in a prominent location on the public Internet website of the Social Security Administration and on the public Internet website of the Centers for Medicare & Medicaid Services, respectively. Effective for fiscal years beginning in the year in which the date of enactment of this paragraph occurs, the Commissioner of Social Security and the Secretary shall enter into an agreement which shall provide funding to cover the administrative costs of the Commissioner’s activities under this paragraph. Such agreement shall— provide funds to the Commissioner for the full cost of the Social Security Administration’s work related to the implementation of this paragraph, including any costs incurred prior to the finalization of such agreement; provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the Commissioner and the Secretary; and require an annual accounting and reconciliation of the actual costs incurred and funds provided under this paragraph. In no case shall funds from the Social Security Administration’s Limitation on Administrative Expenses be used to carry out activities related to the implementation of this paragraph, except as the Commissioner determines is necessary in developing the agreement under clause (i). Nothing in this paragraph shall be construed to relieve the Commissioner of Social Security from any requirement under subsection (c), including the requirement to mail a statement on an annual basis to each eligible individual who is not receiving benefits under title II and for whom a mailing address can be determined through such methods as the Commissioner determines to be appropriate. . Title XI of the Social Security Act ( 42 U.S.C. 1301 et seq.) is amended by inserting after section 1144 the following new section: The Commissioner of Social Security shall distribute the notice to be provided pursuant to section 1143(a)(4), as may be modified under paragraph (2), to individuals in the 24-month waiting period under section 226(b). 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 individuals described in such paragraph. The Commissioner of Social Security and the Secretary shall post the notice required to be distributed under paragraph
(1)in a prominent location on the public Internet website of the Social Security Administration and on the public Internet website of the Centers for Medicare & Medicaid Services, respectively. Beginning not later than 2 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: The notice shall be provided to such individual not later than 3 months prior to the date on which such individual’s enrollment period begins as provided under section 1837. The notice shall subsequently be provided to such individual not later than one month prior to such date. Effective for fiscal years beginning in the year in which the date of enactment of this section occurs, the Commissioner of Social Security and the Secretary shall enter into an agreement which shall provide funding to cover the administrative costs of the Commissioner’s activities under this section. Such agreement shall— provide funds to the Commissioner for the full cost of the Social Security Administration’s work related to the implementation of this section, including any costs incurred prior to the finalization of such agreement; provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the Commissioner and the Secretary; and require an annual accounting and reconciliation of the actual costs incurred and funds provided under this section. In no case shall funds from the Social Security Administration’s Limitation on Administrative Expenses be used to carry out activities related to the implementation of this section, except as the Commissioner determines is necessary in developing the agreement under paragraph (1). . Section 1838(a) of the Social Security Act ( 42 U.S.C. 1395q(a) ) is amended— by amending paragraph
(2)to read as follows: 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, in the case of an individual who first satisfies such paragraph in a month beginning before January 2021 and who enrolls 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, 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 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, in the case of an individual 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, or in the case of an individual who enrolls pursuant to subsection
(e)of section 1837 in a month beginning— before January 1, 2021, the July 1 following the month in which he so enrolls, or on or after January 1, 2021, the first day of the month following the month in which he so enrolls, or ; and by amending paragraph
(3)to read as follows: 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, or on or after the first day of the fourth month of his initial enrollment period, and where such month begins— before January 1, 2021, as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and
(D)of paragraph (2), or on or after January 1, 2021, as prescribed under paragraph (2)(C). . Section 1837 of the Social Security Act ( 42 U.S.C. 1395p ) is amended by adding at the end the following new subsection: Beginning January 1, 2021, the Secretary may establish special enrollment periods in the case of individuals who meet such exceptional conditions as the Secretary may provide, such as individuals who reside in an area with an emergency or disaster as determined by the Secretary. . Section 1838 of the Social Security Act ( 42 U.S.C. 1395q ) is amended by adding at the end the following new subsection: Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to section 1837(m), the coverage period shall begin on a date the Secretary provides in a manner consistent (to the extent practicable) with protecting continuity of health benefit coverage. . Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) ) is amended, in the first sentence, by striking or
(l)and inserting , (l), or
(m). Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) ) is amended by adding at the end the following new sentence: For purposes of determining any increase under this subsection for individuals whose enrollment occurs on or after January 1, 2021, the second sentence of this subsection shall be applied by substituting . close of the month for close of the enrollment period each place it appears. Not later than January 1, 2021, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and Committee on Energy and Commerce of the House of Representatives and the Committee on Finance and Special Committee on Aging of the Senate a report including recommendations on how to align existing Medicare enrollment periods under title XVIII of the Social Security Act, including the general enrollment period under part B of such title and the annual election period under the Medicare Advantage program under part C of such title and under the prescription drug program under part D of such title. Such recommendations shall be consistent with the goals of maximizing coverage continuity and choice and easing beneficiary transition.
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- 42 USC 1320b–13(a)
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Sec. 101
Beneficiary enrollment notification and eligibility simplification
Cite42 USC 1320b–13(a)
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