How often does this occur?
Is this scenario possible, or is my client mistaken? This one is a doozy, bear with me.
I have a person whose birthdate is August 1950. In fall 2015 during Obamacare open enrollment, the beneficiary and his under-65 wife told me he was not eligible for premium-free Medicare due to not having enough work quarters in (probably worked under the table his whole life basically), so in fall of 2015 I put them on a 2016 marketplace plan with subsidy. He is working a W2 job now and they file taxes.
During the 2016 application process, the government did not show that he was covered by Medicare, did not ask for proof or anything. I know they had this capability at this point in time, so he truly was not eligible for (free) part A at the time of their 2016 application in late November 2015.
Fast forward to December 2016 . I previously had called them in November and said that everything would automatically re-enroll if nothing had changed, if something changes call me. They do call me back in December (after the 7th which will become pertinent in a minute), to tell me they have moved and have a new dependent for 2017 (adult child). Also he is now drawing social security. That sends off an alarm bell for me because drawing social security usually means you have enough quarters in to get premium-free A.
Well, something else had changed during 2016, but they didn't think to call me at the time (of course). He has become eligible for premium-free part A Medicare. Oh, and they turned down Part B of course because it was too expensive compared to Obamacare. I asked when did he go onto Medicare, because now the clock is ticking on the Part D and he needs to get off of his (HIGHLY subsidized) marketplace coverage. They tell me in they went down to the office in August or September. I have them come to my office and bring his card, thinking if it was September, at least we can get him on the drug plan.
So, I have them come into my office and bring his card. It says December 2015 is his part A start date. Aye carumba. But they say they don't understand it, because they didn't get notification of his having worked enough quarters or even being able to draw social security until summer 2016. He didn't receive the card until August, it just had a 12/1/2015 date on it.
This now means that 100% of his 2016 subsidy has to be paid back, and also that he is out of open enrollment for a Part D or MAPD (but can't even get the MAPD because he has to wait until General Enrollment for a 7/1/2017 Part B start date).
Can Medicare have back dated from August 2016 back to December 2015?? I assume that when he filed his 2015 taxes, he then had enough quarters in?? I can't believe they would back date it 9 months though. He is saying he definitely didn't decline the B until August.
Is this scenario possible, or is my client mistaken? This one is a doozy, bear with me.
I have a person whose birthdate is August 1950. In fall 2015 during Obamacare open enrollment, the beneficiary and his under-65 wife told me he was not eligible for premium-free Medicare due to not having enough work quarters in (probably worked under the table his whole life basically), so in fall of 2015 I put them on a 2016 marketplace plan with subsidy. He is working a W2 job now and they file taxes.
During the 2016 application process, the government did not show that he was covered by Medicare, did not ask for proof or anything. I know they had this capability at this point in time, so he truly was not eligible for (free) part A at the time of their 2016 application in late November 2015.
Fast forward to December 2016 . I previously had called them in November and said that everything would automatically re-enroll if nothing had changed, if something changes call me. They do call me back in December (after the 7th which will become pertinent in a minute), to tell me they have moved and have a new dependent for 2017 (adult child). Also he is now drawing social security. That sends off an alarm bell for me because drawing social security usually means you have enough quarters in to get premium-free A.
Well, something else had changed during 2016, but they didn't think to call me at the time (of course). He has become eligible for premium-free part A Medicare. Oh, and they turned down Part B of course because it was too expensive compared to Obamacare. I asked when did he go onto Medicare, because now the clock is ticking on the Part D and he needs to get off of his (HIGHLY subsidized) marketplace coverage. They tell me in they went down to the office in August or September. I have them come to my office and bring his card, thinking if it was September, at least we can get him on the drug plan.
So, I have them come into my office and bring his card. It says December 2015 is his part A start date. Aye carumba. But they say they don't understand it, because they didn't get notification of his having worked enough quarters or even being able to draw social security until summer 2016. He didn't receive the card until August, it just had a 12/1/2015 date on it.
This now means that 100% of his 2016 subsidy has to be paid back, and also that he is out of open enrollment for a Part D or MAPD (but can't even get the MAPD because he has to wait until General Enrollment for a 7/1/2017 Part B start date).
Can Medicare have back dated from August 2016 back to December 2015?? I assume that when he filed his 2015 taxes, he then had enough quarters in?? I can't believe they would back date it 9 months though. He is saying he definitely didn't decline the B until August.
