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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

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Beatle Boots  
#1 Posted : Friday, February 19, 2021 12:10:14 PM(UTC)
Beatle Boots

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Background: FERS retiree (turned 65 Nov 5, 2020) planing to keep FEHB (GEHA Std) & also enroll & maintain Medicare Part B coverage. I realize & accept that there is overlapping duplication & I will pay extra. Plan to delay receipt of SS retirement benefits to age 70.

Since I am duplicating health care coverage, I wanted to "TIME MY MEDICARE ENROLLMENT DATE TO SELECT THE LAST POSSIBLE MONTH OF THE INITIAL 7 MONTH ENROLLMENT PERIOD TO AVOID MEDICARES 10% PENALTY.

Here is Medicare's webpage that discusses rules regarding the 6-7 month Penalty Free Medicare Enrollment period for ones 65th birthday (to avoid penalty).

https://www.medicare.gov...a-part-b-sign-up-periods


After reading Medicare's description of the 6-7 month rules (to avoid penalty) I was a little confused. Medicare's example ONLY addresses someone applying EARLY (3 months prior to 65 Bday) not the LATEST POSSIBLE DATE (which would be 3 months AFTER 65 Bday).

I actually prefer the discussion of the 6-7 month rule provided by AARP on this webpage and the paragraph mentioned (understand AARP has no actual authority).

https://www.aarp.org/hea...rolling-in-medicare.html

"Your IEP lasts for seven months: The three months before your birthday month, your birthday month, and the three months after. So, say your birthday is June 15, you'll have from March 1 until September 30 to enroll."

Prior to enrolling for Medicare Part B on Feb 5, 2021, I called SS and spoke to a CS person. I explained what I was trying to do & he said the last time I could enroll penalty free would be anytime in February 2021 (given my Nov 5, 2020 bday). I wasn't confident in his technical knowledge during the call and he had to "speak to the boss" several times. He also refused to transfer me to the boss.

Fast Forward 1: On Feb 5, 2021 I enrolled online on SS' Medicare site for Part B. In the Remarks section. I thoroughly explained that I wanted to enroll PENALTY FREE in the third month following my 65th Bday, which I believed would result in an Effective Enrollment Date of Feb 2021.

Fast Forward 2. On Feb 19, 2021, I get a letter from SSA that says: "Your Medicare Part A starts Nov 2020 & Part B starts Dec 2020.

SS's letter stated my monthly rate is $148.50 (no penalty), but I believe that my Part B effective date should be Feb 2021 which would save me ($148.50 X 2 for months Dec 2020 & Jan 2021).

Fed Soup Request: Would appreciate if a knowledgeable Fed Soup source could opine as to whether or not Feb 2021 is the proper effective date for my Medicare application.

If Feb 2021 is the correct effective date for my Medicare coverage to begin, then I will contact SS and begin "fighting the fight". If I am incorrect, please advise and I will possibly say nothing and perhaps my experience will help others. I don't really want to get stuck paying the penalty which will eventually pay out if I live long enough.

Thanks in advance!





GoHuskers  
#2 Posted : Saturday, February 20, 2021 12:11:14 PM(UTC)

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Yes, the person at SSA really messed up your Part B enrollment. Here is a link to the table of contents for the SSA instructions provided to their employees regarding this. Sections .010 through .030 deal with initial and general enrollment periods and section .165.C explains what the effective date of the Part B coverage should be based on the month within the initial enrollment period in which the application was received. You do not have the option of selecting a month other than the month determined by those rules.

https://secure.ssa.gov/a.../poms.nsf/lnx/0600805000

Your initial enrollment period runs from August 2020 through February 2021. Since you filed the enrollment request in February, which was the last month of the enrollment period, the Part B should actually not be effective until May 2021.

You could have actually made the Part B effective date even later if you had waited until March to file. This is because in addition to the initial enrollment period there is also a general enrollment period that runs January through March of every year. Since your initial enrollment period overlapped with the general enrollment period, an enrollment in February is covered under the initial enrollment period rules. But an enrollment in March would be under the general enrollment period rules, with your Part B coverage not beginning until July of this year.

Something similar to your situation happened when my wife filed for Medicare. We waited until the month she was 65 for her to file which meant Part B should have been effective the following month. But SSA set the Part B date as age 65, meaning we were billed for an extra months premium. I had to go into the local office and file a request for reconsideration of the effective date established to move the effective date to the later month. I actually printed out the actual procedure from the POMS to show them what should have been done. When you contact the office to correct the situation you might want to quote the procedure above to them. I worked for SSA for over 36 years in one of the Payment Centers and the common opinion was that that the people in the local offices,while very dedicated and hard working in dealing with the public, were just not very well trained in some areas.
Beatle Boots  
#3 Posted : Saturday, February 20, 2021 1:19:55 PM(UTC)
Beatle Boots

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Originally Posted by: GoHuskers Go to Quoted Post


Something similar to your situation happened when my wife filed for Medicare. We waited until the month she was 65 for her to file which meant Part B should have been effective the following month. But SSA set the Part B date as age 65, meaning we were billed for an extra months premium. I had to go into the local office and file a request for reconsideration of the effective date established to move the effective date to the later month. I actually printed out the actual procedure from the POMS to show them what should have been done.


Thank you so Much GoHuskers! Wow wish I would have known all this before I started process. If it is ok, I have a follow-up question on to effectively appeal to SSA for "Request for Reconsideration of the Effective Date Established".

(1) Given Covid, how should I plan my appeal today?

(2) Is there any way to handle this by phone and bypass the random CS person who answers my call?

Note: Last time I called SS and got a random CS,to discuss my Enrollment Plans, he refused on 3 instances to let me talk to his boss. To me given the circumstances & dates of my application, I would think that a fairly low level employee could verify dates & SS summary level 7 months rules on SS webpage (no need to get into weeds of POMS), the Remarks on my application, & quickly conclude that SS used the wrong effective date. However, I have no idea the level of training and authority that the average SS employee has.

Thank you again!


GoHuskers  
#4 Posted : Saturday, February 20, 2021 2:36:52 PM(UTC)

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Requests for reconsideration have to be in writing and are handled by personnel in the Payment Centers, not in the local offices.

The first thing you should do is go download the form to request a reconsideration of the Part B entitlement date that was established.

https://www.ssa.gov/forms/ssa-561-u2.pdf

I've been retired for over 10 years and am not up-to-date on all the adjustments SSA has made due to COVID but do know that almost all employees are working remotely from home at the moment, which is why making contact with someone is more difficult. Check the award letter that you received. It should have instructions on what to do if you disagree with the decision. If it provides an address to use for the appeal, mail it there. If it doesn't and just says to call if you disagree, you'll have to do that. If you have a phone number for you local office, as opposed to the national 800# (not easy to find since SSA tries to direct the public to the 800#), I'd certainly try calling there first and asking them where to mail the appeal. My understanding is that many of the local offices have a small number of employees, mainly managers, working on site to handle things that must be done face to face but you would need an appointment to see them, you can't currently just walk into the office. I'm not sure this situation would qualify for a face to face meeting, but if they answer the phone they should at least be able to tell you where to send the appeal. Sorry I can't be of more help.
Beatle Boots  
#5 Posted : Saturday, February 20, 2021 4:31:34 PM(UTC)
Beatle Boots

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GoHuskers Thank you So Much!!!!

Read your response and everything checks out and makes sense.  I am mentally preparing my claim and am hoping you can give me your valuable professional opinion on my suggested CLAIM REMEDY (which month should SS use?).

As I mentioned, prior to submitting my application I contacted SS' 1-800 line and talked to a CS rep.  I may have a call date written to reference in my claim.  Also, I am unsure if the CS reps are required to maintain a call record by date & caller SSN and a summary of questions asked & advice provided? If so, this info may bolster & corroborate my claim.

During the CS call, I clearly outlined my intent on obtaining "The Latest Possible Medicare Enrollment Date that Would Ensure NO Penalty".  The CS clearly stated that I needed to submit my claim in Feb 2021.  The CS instructed me to include this info in the Remarks section of my claim.  So I did.  Specifically, I included the following verbatim remarks:

"I am a Federal Civil Service RETIREE who has elected to keep Federal Employee Health Insurance (FEHB) indefinitely.  I realize that I will pay for duplicated health insurance with Medicare & FEHB. I understand the Medicare will be the primary insurer once both polices are in effect.  I wish to enroll in Medicare A&B with a "Delayed Effective Date" as late as possible to avoid paying:  (i) Medicare late enrollment penalty & (ii) double Medicare & FEHB monthly premiums.  Specifically, I request my medicare app to be processes as follows:

(1) Sign Up Date - No earlier or later than 3 months after my 65th birthday (11/5/2020), & (2) Delayed Effective Coverage Start Date - No earlier or later than 3 months after 65 bday.

GoHusker Question:  Given the information above, Which Specific Month should I request SS use for my Medicare effective date (for coverage & monthly payment) to begin?

Note you mentioned some POMS exception rules that I was not aware of and I am wondering if you think I may be able to ask for & be awarded a later date based on POMS rules?

Thanks so much!
GoHuskers  
#6 Posted : Sunday, February 21, 2021 12:35:48 PM(UTC)

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If the application was actually filed this month (February) then the Part B should start effective May 2021.

I think that in order to make the Part B effective date July 2021 you would normally need to completely withdraw the application you have already filed and then file a new application in March. If you look in Section .080 of the POMS chapter I linked above it covers requesting the withdrawal of an application. As long as you request withdrawal within 2 months of when you filed the application it should be honored. But with it already being late February there are some timing issues that might result in an even bigger mess if you go that route as I doubt if SSA would get around to approving the withdrawal and notifying you of the approval before the end of March. As an alternative you might be able to avoid that hassle by just requesting equitable relief instead of just reconsideration (can still use the same form). Sections .170 through .210 of the POMS chapter cover this.

You might include a statement such as "As a federal retiree with FEHB coverage, my intent when filing for Part B was to have it start at the latest possible month to still avoid a 10% penalty increase. This intent was clearly indicated in the remarks I included on my application. Pursuant to a discussion with one of your 800# representatives, I filed my Part B enrollment request in February 2021, which is the last month of my initial enrollment period. Per SSA instructions in POMS HI 00805.165 the effective date of my Part B enrollment should be May 2021 based on that filing date. You have erroneously enrolled me in Part B effective December 2020. I have since learned that I could have waited until March of 2021 and filed for Part B in the last month of the 2021 general enrollment period. Then, the part B enrollment would be effective July 2021. At a minimum my Part B effective date should be changed to May 2021 based on the date I actually filed the application. In addition, I relied on incorrect advise provided by the SSA representative when deciding to file the application in February. If correct advise had been provided I would have waited until March to file. Therefore, I believe that the equitable relief provisions are applicable, and that you should change my Part B entitlement date to July 2021 to conform to my intentions."

What I'm wondering is if someone did make a record of your call to the 800# and SSA somehow used the date of that call as what is considered a protective filing date for the application. Did you perhaps make the call to the 800# last November? I ask because the Part B entitlement date established would only be correct if the application was filed in November. But even if that is when you called the 800# my recollection is that protective filing dates are not applicable for Medicare only claims, and in any case a protective filing date should not be used if it would result in an entitlement date that is contrary to the wishes of the claimant.
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