H.R. 4960

119 HR 4960 IH: Beneficiary Enrollment Notification and Eligibility Simplification 2.0 Act
 U.S. House of Representatives
 2025-08-12
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 I  119th CONGRESS  1st Session  H. R. 4960  IN THE HOUSE OF REPRESENTATIVES   August 12, 2025   Mr. Ruiz  (for himself,  Mr. Evans of Pennsylvania ,  Mr. Bilirakis , and  Mr. Schneider ) introduced the following bill; which was referred to the  Committee on Ways and Means , and in addition to the Committee on  Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned   A BILL
To amend title XVIII of the Social Security Act to establish a system to notify individuals approaching Medicare eligibility.
1.
Short title
This Act may be cited as the   Beneficiary Enrollment Notification and Eligibility Simplification 2.0 Act   or the   BENES 2.0 Act  .
2.
Beneficiary enrollment notification and eligibility simplification
(a)
Eligibility and enrollment notices
(1)
As part of social security account statement for individuals attaining ages 60 to 65
(A)
In general
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:
(4)
Medicare eligibility information
(A)
In general
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 60, 61, 62, 63, 64 and 65, the statement shall also include a notice containing the information described in subparagraph (B).
(B)
Contents of notice
The notice required under subparagraph (A) shall include a clear, simple explanation of—
(i)
eligibility for benefits under the Medicare program under title XVIII, and in particular benefits under part B of such title;
(ii)
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 such part B;
(iii)
the availability of relief from such 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;
(iv)
coordination of benefits (including primary and secondary coverage scenarios) pursuant to section 1862(b), in particular for benefits under such part B;
(v)
enrollment, eligibility, and coordination of benefits under title XVIII with respect to populations, for whom there are special considerations, such as residents of Puerto Rico and veterans; and
(vi)
online resources and toll-free telephone numbers of the Social Security Administration and the Centers for Medicare & Medicaid Services (including 1–800–MEDICARE and the national toll-free number of the Social Security Administration) that provide information on eligibility for benefits under the Medicare program under title XVIII.
(C)
Development of notice
(i)
In general
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).
(ii)
Request for information
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.
(iii)
Notice improvement
Beginning 4 years after the date of the enactment of this paragraph, and not less than once every 2 years thereafter, the Secretary, in coordination with the Commissioner of Social Security, shall—
(I)
review the content of the notice to be provided under subparagraph (A);
(II)
request written information, including recommendations, on such notice through a request for information process as described in clause (ii); and
(III)
update and revise such notice as the Secretary deems appropriate.
(D)
Groups
For purposes of subparagraph (C)(ii), the groups described in this subparagraph include the following:
(i)
Individuals who are 60 years of age or older.
(ii)
Veterans.
(iii)
Individuals with disabilities.
(iv)
Individuals with end stage renal disease.
(v)
Low-income individuals and families.
(vi)
Employers (including human resources professionals).
(vii)
States (including representatives of State-run Health Insurance Exchanges, Medicaid offices, and Departments of Insurance).
(viii)
State Health Insurance Assistance Programs.
(ix)
Health insurers.
(x)
Health insurance agents and brokers.
(xi)
Such other groups as specified by the Secretary.
(E)
Posting of notice on websites
The Commissioner of Social Security and the Secretary shall post the notice required under subparagraph (A) on the public internet website of the Social Security Administration and on Medicare.gov (or a successor website), respectively.
(F)
No effect on obligation to mail statements
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.
 .
(B)
Timing of statements
Section 1143(c)(2) of the Social Security Act ( 42 U.S.C. 1320b–13(c)(2) ) is amended by adding at the end the following new sentence:  With respect to statements provided to individuals who are attaining age 65, as described in subsection (a)(4), such statements shall be mailed not earlier than 6 months and not later than 3 months before the individual attains such age. .
(2)
Social security beneficiaries
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:
1144A.
Medicare enrollment notification and eligibility notices for Social Security beneficiaries prior to medicare eligibility
(a)
Notices
(1)
In general
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 entitled to monthly insurance benefits under title II in accordance with subsection (b).
(2)
Authority to modify notice
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.
(3)
Posting of notice on websites
The Commissioner of Social Security and the Secretary shall post the notice required to be distributed under paragraph (1) on the public internet website of the Social Security Administration and on Medicare.gov (or a successor website), respectively.
(b)
Timing
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 described in such subsection—
(1)
in the third month before the date on which such individual’s initial enrollment period begins as provided under section 1837; and
(2)
in the case of an individual with respect to whom section 226(b) applies (except for an individual who will attain age 65 during the 24 month period described in such section), in the month before such date on which such individual’s initial enrollment period so begins.
 .