Medicare won't let this 68-year-old cancer patient enroll in Part B. It's costing her thousands.
Medicare 's many enrollment rules can leave beneficiaries with gaps in coverage if they don't sign up when they are supposed to.
Unaware of the rules, Poulet remained covered under COBRA until three months ago. She did not qualify for a special enrollment period for Medicare.With no insurance for outpatient care, Poulet's most recent cancer-related appointment cost $5,563 out of pocket. And that was after requesting financial relief from the original $7,974 price tag.
Poulet said her next step would be to request "equitable relief." This basically involves asking the Social Security Administration to allow her to enroll in Part B immediately and eliminate late-enrollment penalties, although the request generally must involve proof that an agent of the government provided inaccurate information that led to the mistake.
There's no guarantee the plea will work or how long a decision would take. Other federal rules prohibit Poulet from getting a health plan through the public marketplace. She also does not qualify for Medicaid, which places limits on how much income and savings a person can have. headtopics.com
"I lost my insurance, I have cancer, the pandemic is getting worse, and I'm supposed to wait until [July] to sign up?" Poulet said. "It's like they're saying you didn't sign up for Part B so we're gonna put you out to pasture and shoot you."
The BENES Act — the legislation taking effect in 2023 that fixes some Medicare coverage delays — also authorizes the government to allow Part B special enrollment periods for "exceptional circumstances." (This already exists for Part D prescription drug coverage and Part C Advantage Plans.)
The problem is not that COBRA coverage is available, it's that there is not support for these transitions.Casey SchwarzSenior counsel for education and federal policy at the Medicare Rights CenterExactly what will qualify at this point is uncertain. In other words, there's no way of knowing whether the definition would include mistakes related to employer-based coverage, including COBRA.
Advocates say that when people find themselves in Poulet's situation — unable to enroll and/or facing penalties — it generally is due to thinking they're doing the right thing and there's no one telling them otherwise."It's especially hard in situations where people have been paying premiums for other insurance, especially under COBRA," said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. headtopics.com
"They say 'clearly I wasn't trying to game anything because I was paying more for premiums than I would have for Part B,'" Schwarz said.Poulet and Kujawa's premiums under COBRA were $1,686 monthly, compared with this year's standard Medicare Part B premium of $148.50 a month ($170.10 next year).
One provision that did not make it into the BENES Act but is supported by advocates would require the government to notify individuals approaching Medicare eligibility about enrollment rules.Read more: CNBC »
NPR Cookie Consent and Choices
An easy solution for Medicare signup, start taking SS 4+ months before 65 and you're automatically enrolled in Medicare A&B. Advisors that tell you to postpone SS are only looking at retire $'s, not healthcare. There is likely another reason why Medicare will not let her enroll,she failed to tell you it.
I'm sorry that you are having so much trouble with part B. Who made the law?
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