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Reader Alert:  Many employer benefit group plans terminate the day you are no longer working full-time.  Explore employer group medical plan rules and options with Medicare if you or your spouse are 65 or older.

 

Toni:

I need your Medicare guidance because this March, I was rushed to the ER because of kidney failure caused from stage 4 of prostate cancer that has now spread to my pelvic bones.

Because I was working full-time, I took a leave of absence with short-term disability in January for 60 days while receiving my cancer treatment.  Short term disability ended on March 15^th and so I was placed on long term disability.

I was informed, while in the hospital for cancer treatment, that I had qualified for long term disability and would no longer be part of the company’s health plan since I was not a full-time employee. COBRA would begin immediately.

My wife and I enrolled and paid for COBRA, so that I could continue with medical care where I am having cancer treatment. It took 6 weeks to get the paperwork to Social Security for me to enroll in Part B, since I was not working full-time, and my Medicare Part B began June 1^st.

Now my Cobra nightmare begins… because COBRA is only paying the 20% of medical/doctor bills and I was billed the 80% because I was not enrolled in Medicare Part B which has totaled over $40K.

Please help me solve this COBRA financial nightmare…Thanks, Robert, San Diego

Robert:

The Toni Says team will do all that we can to help you solve this problem with your $40K Medicare Part B medical bill fiasco.

Those reading this article need to realize the seriousness of Medicare and insurance rules.

The Medicare & You handbook discusses topics such as “Special Enrollment Period” and “Should I Get Part B”.  It states that COBRA is not considered coverage based on current employer benefits.

You have 8 months to sign up for Medicare Part B without a penalty if you are not “working full-time or have lost your company benefits whichever comes first.  The 8-month period will run whether you choose COBRA or not. If you choose COBRA, do not wait until your COBRA ends in 18 months to enroll in Part B. This time period is past the 8-month period, and one will receive the famous “Medicare Part B penalty which go all the way back to when one enrolled in Medicare Part A.

Robert, you did everything correctly to enroll in Medicare Part B by contacting Social Security and faxing the CMS-L564 form “Request for Employment Information” signed by your company’s HR and CMS-40B form “Application for Part B”.  You were within the correct time limits.

You are in a Medicare “glitch” and the insurance plan is using “Coordination of Benefits” as their ruling.

Group health insurance plans are a state regulated plan not a Medicare regulated plan.  Since you are past 65 and already enrolled in Medicare Part A, the health plan is passing the 80% of the doctor/medical bills on Part B to Medicare. You were not enrolled in Medicare Part B yet to pick up the difference.

It will take time to straighten this out but there is hope for you. The Toni Says® Medicare team is here to fight for you!

The good news is that COBRA plans are a creditable prescription drug coverage plans and you are eligible for a Special Enrollment Period for Medicare Part D without receiving a Medicare Part D penalty.

Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question? Call 832/519-8664 or email info@tonisays.com.