Real Tricky One

Sep 14, 2016

  1. kstein
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    I have a disability Medicare client who has end stage renal disease. He became eligible for part A and Part B in November of 2015. He was also on a heavily subsidized ACA plan and for whatever reason declined Part B to keep his ACA policy. The ACA plan finally realized that he was eligible for Medicare and terminated him as of August 1st of this year. Does he have any recourse or does anyone know a way to get him enrolled into Part B ASAP?
     
    kstein, Sep 14, 2016
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  2. vic120
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    As far as I know if one is covered but is not working and loses that coverage is Not eligible for Part B enrollment out of general election

    the only exemption I could think of is if one has cobra but runs full course of cobra or one just became US citizen

    ----------

    I'm Actually thinking of GI rules with the above post, However I do remember having issue with getting part B when someone lost retirement group cov, The reason was because the person hasn't worked in some time.
     
    vic120, Sep 14, 2016
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  3. TN_agent
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    WOW, who told him to decline B while in ESRD? He probably was paying $50 a month for the obamacare plan with MOOP of $600 a year and thought "oh man, no way I am paying $105 a month, that is a ripoff" not understanding exactly what he was doing.


    My gut is telling me this guy is screwed until July 1st 2017. I have had this happen to several people who for whatever reason were too cheap to take out the B, and social security/Medicare would not let any of them enroll outside of GEP when they declined B that long ago and hadn't been actively working. Can try to appeal maybe because of the ESRD, but I would say it is a VERY long shot.
     
    TN_agent, Sep 14, 2016
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  4. kstein
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    TN agent you hit the nail on the head. He is in an Ltc facility too. I just got in the picture so I definitely didn't tell him that.

    How do you appeal a part B decision?
     
    kstein, Sep 14, 2016
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  5. TN_agent
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    I guess go on and apply for the B. (it will get denied). I am sure there is some mechanism on the denial letter to appeal. (I don't help people do appeals with Medicare stuff, those people will suck down all your time) But I wouldn't hold my breath for Medicare/SSA to change their minds.

    Is he on dialysis? Who has been paying for that these past 6 weeks? Will your state Medicaid pick that up if he is QMB without part b? If not on dialysis, maybe he can hold out until July 2017...
     
    TN_agent, Sep 14, 2016
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  6. DS4
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    To add insult to injury, for the months he was eligible for Part A & B prior to 8.1.16, he will have to pay back the exchange for the APTC.
     
    DS4, Sep 14, 2016
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  7. kstein
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    Ya he is on dialysis and his credit is $700/mo. He makes about 1600/mo w ss benefits only. I tried to tell him that he really made a mistake by cancelling B but didn't want to kick him while he is down.

    He is on Medicaid in Missouri but I'm not sure if Medicaid will pay when Medicare part B doesn't cover claims first.

    To further rub salt in the wound, he would have got his Part B premium reimbursed and the AKF will pay 100% of his med sup for him. Also the fact that he pays a premium doesn't matter (if the B didn't get refunded) BC he is on institutional Medicaid so any extra expense just comes out of the Ltc facilities pocket and reimbursed by Medicaid, at least to certain extents and my knowledge.
     
    kstein, Sep 14, 2016
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  8. Rollem
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    Medicaid? How long has he been in the facility and is he likely to stay?
     
    Rollem, Sep 15, 2016
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  9. yogooglethis
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    Short answer is no.The best thing you can do for him now is apply for LIS and get him PDP and also apply for state share of cost medicaid.each state is different but there is no income limit for share of cost in most states - it is based on ratio of medical expenses to income so he would definitely qualify in Fl.

    This is a charity case for an agent because at his income and frugalness level he is not going to buy a med supp and he cant qualify for MA
     
  10. Chazm
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    Funny this exact phone call happened to me today. Called a t65 lead card and tried to set an apt to see him. He asked "isn't Medicare free"? I explained to him the cost and he said well I'll just keep my Obamacare plan that cost $50/month. I let him know that if he's eligible for part B he will be dis enrolled from his ACA plan and if he somehow fell through the cracks and was able to keep it the IRS would come back demanding the subsidies he received.
    This guy then claims that he gets zero govt help for his $50 Coventry premium. He pays the premium himself and he'll just keep that.

    I said well obviously you know more then me about Medicare so I hope you have a good day.
     
    Chazm, Sep 16, 2016
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