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SHINE: Serving the Heath Insurance Needs of Everyone

Special Enrollment Period into Medicare Part B with penalty waived

Lorraine York EdbergLorraine York-Edberg

Did you choose not to enroll in Medicare Part B when you became eligible, because you mistakenly believed that you could continue with Marketplace coverage with subsidies?

Many people newly eligible for Medicare thought it would be cheaper to remain in the Marketplace with subsidies, rather than pay Part B premiums, but did not realize that their Medicare Part A eligibility made them ineligible for premium subsidies, also called Advance Premium Tax Credits (APTC). When they realized their mistake, they were past their initial enrollment period and could only enroll in Part B during a General Enrollment Period, often incurring Part B late enrollment penalties.

For a limited time, you can also apply for equitable relief that will give you a Special Enrollment Period to enroll in Part B. In addition, Part B late enrollment penalties will not apply.

CMS (Centers for Medicare & Medicaid Services) has mailed notices to individuals 65 and over in this situation, advising them to drop Marketplace coverage and enroll in Part B instead.

THE DEADLINE FOR APPLICATIONS IS MARCH 31, 2017.

SSA (Social Security Administration) and CMS are not publicizing this equitable relief opportunity, and it is not discussed in the notice.

Individuals who received the notice, those who have concerns about not having Marketplace subsidies even if they did not receive a notice (or lost it), or those who received misinformation about qualifying for tax credits should contact the Social Security Administration to apply for equitable relief.

Individuals should apply if they had any confusion and misunderstanding about the availability of tax credits or how their Medicare eligibility affected them.

Individuals should submit any information or documentation they have on how they learned that the subsidies would not apply and/or why they had thought they could continue subsidies. Any letters (including the notice referenced above), emails, notes from conversations, information about problems for a Late Enrollment Penalty, or other information that might be relevant should be included. For this relief, it is not necessary that the source of confusion be directly from a federal employee.

Consumers with questions should be directed to the Medicare Rights Center helpline where counselors can assist with questions. The helpline number is 1-800-333-4114. For a fact sheet regarding Equitable Relief and sample letter to Social Security, click here.

This article was written in cooperation with Justice in Aging.

More information about the SHINE program

For more help understanding your prescription drug options and other questions pertaining to Medicare, contact the SHINE (Serving the Health Insurance Needs of Everyone) program at LifePath for free, confidential, and unbiased health insurance counseling. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555. Learn more about SHINE online.