Unique situation - Any advice?

[Rossat]

ACA client was on the marketplace for past 2 years.
A few months ago receives notice that CMS is reporting to the marketplace of active Medicare coverage. Marketplace is terming policy.

Part A is showing active from 2011.
Part B shows ending 2013.

Client, years ago, received SSDI, and was automatically enrolled into Medicare in 2011. They went back to work in 2013. SSDI stopped. Part B ended (apparently due to LOP--he found out now). Client had employer coverage for years those years 2013-2021. 2021 Client stops working as disability progresses. Seeks coverage on the Marketplace in 2022.

Fast forward to 2024. Client officially goes back on SSDI 04/2024. No backdating.

Part A is (and apparently has been) showing active and therefore cannot get Marketplace coverage. HOWEVER, they are advising they must wait 24 months now to be eligible for Part B. According to SS, the client cannot cancel Part A because it's premium free.

It seems to be one of those odd scenarios where these rules are actually preventing someone from getting coverage. What I don't understand is how someone can maintain Part A after 13+ years while not collecting SSDI for 11 of those years.

 

[axeman462]

advise the client to hire a disability lawyer

 

[rmhaire]

How old is your client?

Always start with their T65 and work backwards.

A trip to the SS office with a letter from his doctor could be his easiest fix. He's already met his two year wait so he needs to try and get it back.

Start here:

Medicare Information | Disability Research | SSA

This page provide general information about Medicare.

www.ssa.gov

 

[Rossat]

He's in his late 40's.

I appreciate the link. I read this myself. As it states, you can continue Part A up until 8 1/2 years. My guess here is at some point there's a time that broke the 8 1/2 year mark and they kept on him on premium free Part A.

What's odd is that if this is true, he shouldn't have to wait 24 months to get the Part B but should be able to enroll during the GEP. However, he's being told he needs to wait 24 months.

 

[rmhaire]

He's in his late 40's.

I appreciate the link. I read this myself. As it states, you can continue Part A up until 8 1/2 years. My guess here is at some point there's a time that broke the 8 1/2 year mark and they kept on him on premium free Part A.

What's odd is that if this is true, he shouldn't have to wait 24 months to get the Part B but should be able to enroll during the GEP. However, he's being told he needs to wait 24 months.

Assuming it's the same disability, he's already met his 24 month waiting period. Most likely he's dealing with an *** that doesn't know SS regulations. I see that a lot.

He should call or go back and talk with someone else. He can file an appeal. But waiting 24 months is bs.

Once he gets part B back, he gets a complete do-over with a medicare supplement. No health questions.

 

[Rossat]

Assuming it's the same disability, he's already met his 24 month waiting period. Most likely he's dealing with an *** that doesn't know SS regulations. I see that a lot.

He should call or go back and talk with someone else. He can file an appeal. But waiting 24 months is bs.

Once he gets part B back, he gets a complete do-over with a medicare supplement. No health questions.

I'm thinking the same thing. I keep tell them I think the primary issue is SSA reps are advising incorrect info. First they say it's 24 months, then he missed the window, then its back to 24 months, and so on. I think we just need to talk with someone who knows whats going on and can highlight the necessary course of action.

if he has to wait until the GEP that's fine, but he's not even being told that.