There is relief available to some seniors who have incurred a penalty for their late enrollment in Medicare Part B coverage.
Generally, seniors are eligible for Medicare at age 65, when they can receive benefits under Part A (hospital coverage), Part B (outpatient medical coverage), and Part D (prescription drug coverage).
In many cases, seniors apply for Part B coverage during the seven-month initial enrollment period, when Part A is available. In other cases, certain qualified seniors may opt to delay applying for Part B coverage until a later special enrollment period. However, unqualified seniors who delay applying for Part B coverage will eventually incur a steep, permanent penalty of a 10-percent increase in monthly premium payments when they finally enroll.
As it turns out, some seniors did not apply for Part B coverage when they were first eligible. Instead, some of these seniors opted for dual coverage through a combination of Medicare Part A and the less-expensive health coverage through the marketplace affiliated with the Affordable Care Act. Because the marketplace plans are not equivalent to the Part B coverage, those seniors have now incurred a stiff penalty for Part B late enrollment.
How Do You Qualify?
Fortunately, the Centers for Medicare and Medicaid Services (CMS) has offered relief to these particular dually-enrolled seniors by allowing them to enroll in Medicare Part B without a penalty. CMS is also reducing the penalty for those who dropped marketplace coverage and are now paying the Part B late-enrollment fee. CMS has recently extended the deadline to apply for this relief to Sept. 30, 2018
These dually-enrolled seniors who are eligible for this equitable relief may qualify in the following ways:
- Their initial Medicare enrollment period began April 1, 2013, or later;
- They were either notified of retroactive eligibility for premium-free Medicare Part A on Oct. 1, 2013, or later, or had a Part B special enrollment period that ended Oct. 1, 2013, or later;
- They currently have premium-free Part A and are not enrolled in Part B or have a Part B late-penalty assessed from late enrollment in 2015-18;
- They must provide documentation showing enrollment in the marketplace;
- This relief is requested by Sept. 30, 2018.
For most individuals who seek this relief, Part B coverage will begin the month of enrollment. CMS encourages seniors who seek this relief to consult their local Social Security office with case-specific questions about this equitable relief.
Kara Gansmann is an attorney in the Wilmington office of Cranfill Sumner & Hartzog LLP, where her practice encompasses elder law and estate planning. Kara advises individuals and families with estate planning needs and asset protection tactics. In this role, she strategizes with clients to preserve assets for long-term care and to leave legacy gifts to family members. Kara works with elderly clients in need of Medicaid crisis planning and Medicaid applications. As part of her practice, Kara drafts wills, trusts and powers of attorney. In the courtroom, Kara represents clients in the administration of estates, guardianship/incompetency proceedings, and guardianship administration. Kara also litigates estate and trust matters, including will caveats, the modification or termination of trusts, and litigation arising from estate documents or fiduciary roles. She is a member of the North Carolina Bar Association Elder Law and Special Needs Section and serves as co-chair of the CLE Committee for that section. Kara also serves as a liaison between the North Carolina Bar Association Elder Law and Special Needs Section and the North Carolina Bar Association Estate Planning and Fiduciary Law Section.