SSDI, Offered Medicare, Refused

[somarco]

Contacted by a guy with a question about U65 Medicare. His email to me ....

Wife has stage 4 cancer. Carried on group plan as active employee until last year.

Under 65 on disability since July 2013. Primary insurance through her employer. She was terminated in Oct 2014, but of course we maintained insurance through her employer (not COBRA) but be pay a monthly amount similar to when she was active employee.

Well she got Medicare package last fall called both Medicare , Insurance company , and employer and was told could decline Medicare.

Now we are told thats not true and she should not have declined.

She has been dealing with this since Feb.

We were told she would be eligible for Special enrollment, jumped through hoops and now that was denied.

AFAIK, once you refuse A & B when offered due to SSDI that's it. No mulligans. But maybe there is.

I know COBRA and Mcare do not play well together, but (apparently) she isn't on COBRA (yet).

Only thing I could think of was trying for an SEP for Obamacare.

Other insight or suggestions?

 

[roadrunner]

I just had a similiar situation.

If you have Medicare Part A (Hospital Insurance), you’re considered covered and won’t need a Marketplace plan. Having Medicare Part B (Medical Insurance) alone doesn’t meet this requirement.

What if someone tries to sell me a Marketplace plan?

It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

In your situation the person opted out of Medicare, so technically she does not have access to Medicare. But I believe somewhere in the law it states if you stay on Marketplace and are eligible for Medicare you say bye bye to subsidies.

 

[somarco]

This person wants to get back on Mcare but don't think a Mulligan is allowed if you are under 65.

Doesn't really want Ocare but is better than nothing. And yes, I think you are right about no subsidies.

 

[yorkriver1]

They should apply on Marketplace for coverage and see what happens. If she can't get back on Medicare, then she's not eligible for it, right? She's not covered under A, if I understand correctly. If covered on A or B, or both, then, yes, no tax credit.

I have a client from away who doesn't yet have 40 quarters for Medicare, so although age 67, still eligible for ACA with tax credit. Still working for 2 more years, no group insurance at work. There was no problem with the app. I told him that he will have more out of pocket once he goes on Medicare. They are pretty low income.

Now, for a SEP, Marketplace told me this week, the loss of group coverage or COBRA running out will require a document proving the date of loss of that coverage, within last 60 days prior to the application. They will have 90 days, like for other proof docs.

One other thing, which is, depending on her condition, if it's more severe than before, it could be worth checking if the client may fall into one of the "fast track" or "compassionate allowance" conditions that qualify for rapid acceptance for SSDI. We helped one of my husband's friends with that. It was done in 3-6 weeks.
https://www.ssa.gov/disabilityresearch/fast-track.htm

 

[somarco]

It's not that simple.

She is under age 65. It is my understanding if you refuse Mcare that's it. Game over.

Apparently Mcare confirms that, even refusing to let her apply during the General Election Period.

Maybe the exchange is playing by the rules now. As recently as Jan, 2016 agents have reported HIX granting an SEP "just because" and no documentation required.

And she is already on SSDI. The medical coverage is the problem.

 

[yorkriver1]

Medicare can be unforgiving. I just read on p. 111 of Medicare for Dummies, "you can't opt out of Part A if you receive Social Security benefits." This goes for those on SSDI, too. So, something doesn't add up. If Part B is the issue, an unbroken chain of past employer benefits is the key.
Both Medicare and the Marketplace could try to be be appealed, if employer error was involved. This situation with the employer, if they gave the advice, is what employer purchased employee benefits liability coverage is for.

Marketplace announced (CMS) a few weeks ago that for a SEP, loss of coverage would need a letter from the employer within 90 days of app to keep coverage. They seem to have started enforcing in the last week or two. So, for off Marketplace, no letter, no coverage from day 1. On Marketplace coverage could be in place for some months with or without letter. Of course, if denied after 90+days, tax credit would be revoked.

 

[somarco]

I know about the issue with SS and refusing Medicare, but didn't think of it when corresponding with this person. (He lives in another state and reached out to me after reading some of my internet posts about Medicare). In fact, I had blogged on the SS/Medicare issue several years ago. Here is a good summary of the problem.

You Can't Opt Out of Medicare Without Losing Social Security, Judge Rules | ElderLawAnswers

Perhaps his wife just refused B, but that doesn't make sense.

Per my original post, he asked the employer, carrier and Medicare before declining. When they later discovered that may have been the wrong decision they tried to get Medicare (possibly just Part B) but were refused.

I'm afraid this is a case of he said, she said with no one to blame.

 

[G.Gordon]

Chances are 99% sure that they only turned off part B due to employer insurance, otherwise they would have lost the SS check as well and that would certainly cause one to reverse their decision.

The problem with cases like this is that they probably didn't ask the right questions with the right words. She was on a continuation plan, not employer plan, the difference is that you have a part B sep at the end of work. Since she is not and has not been working, she is outside the eight month SEP.

We had a similar issue with a telecom company that extended laid off emps benefits for a time that was determined by the years of employment. For some this was 6-14 months of paid for coverage. Many chose the wrong way to go if they were eligible for Medicare, that they were still on their employer plan, but they were not on "due to active work", that is key. Many were locked out until the next general enrollment and do have a penalty. They were all given the same advise, but blaming someone else absent of written proof is of no value.

Having part A only keeps her out of getting help on ACA, she still has the right to purchase coverage if she is losing coverage in the past or next 60 days.

If she lost her coverage more than 60 days, she is SOL until AEP.

The only part I'm confused about and if this is so it is a learning opportunity for me. She turned off part B due to other coverage, even if it was a mistake. Are you saying that SS is not allowing her to elect part B during the GEP because she is SSDI and turned it off? I'll have to read up on that issue. I'd ask SS for writing proof of that restriction if you can't find it.

 

[somarco]

Thanks for entering the discussion.

All I know is what I have posted above plus the initial email correspondence where the husband indicated the wife had stage 4 breast cancer.

I emailed him earlier for a clarification on Mcare. Did she take A but refuse B? Does she have any coverage now? (I suspect not). Is she collecting SS?

As far as I can tell there is no written correspondence other than (presumably) the denial of picking up Mcare during the GEP.

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Got another email.

Wife has Part A and group insurance. He isn't sure if she is carried as a regular employee (not at work) or retiree.

Also said Mcare agreed to Part B effective July 1.

Hospital (inpatient and/or outpatient) has agreed to treat them as indigent and write down claims.

Not sure how that will work if she has Part A and the group plan.

 

[yorkriver1]

I have clients who had the balance of their bills after the insurance had paid written down on a sliding scale by hospital based providers, including hospital bills.