disability secrets.com/social-security-office-lost-my-appeal-paperwork-what-do-i

We did have a client who reported that her local Congressperson helped her out and got the problem resolved.

• house.gov/find-your-representative

• nytimes.com/how-senators-and-representatives-can-help-constituents

   

Use this tool to determine when you are eligible for Medicare.

Your Initial Enrollment Period based on your age

Your Initial Enrollment Period based on your age contextual help
October 1, 2019 – April 30, 2020

Medicare is for people age 65 and older and those who have special condition or disability. You’re not eligible to enroll in Medicare now because you don’t meet the special condition/disability requirements.

If you’re a U.S. citizen or you meet the lawful presence and residency requirements, the Initial Enrollment Period (IEP) is your first chance to sign up for Medicare. It starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after the month you turn 65.

Sign up for Medicare

Costs for Medicare since you won’t get it for free…

Costs for Medicare… How does that compare to the under 65 plan you have now?

See our webpage on that

• Medicare enrollment, if covered by Employer Plan? Retiring?

Yes, everything Parts A Hospital, B Doctor Visits, Medi Gap, Medicare Advantage and Part D Rx automatically renew.

I’m having trouble finding citable sources. I don’t count other agent websites, as it seems I’m the only one, who cites a source.

https://www.medicare.gov/pubs/pdf/10050-medicare-and-you.pdf

Didn’t you get a January bill for Parts A & B? Just pay it.

Part B Doctor Visits is exactly the same for everyone.

To get the “best” greatest selection of MD and providers you would want to sign up for a Medi Gap plan. Plan F has the most comprehensive benefits. This would be most similar to PPO and not the restrictive provider lists in a Medicare Advantage Plan (MAPD). MAPD though generally has zero premium.

If you are thinking of keeping your COBRA beyond age 65 and not getting Part B, that won’t work, see Medicare Publication 11036 Enrolling in A & B page 13.

See link above to use our Blue Cross and Blue Shield affiliate sites to view benefits, pricing and enroll online. We also have tons of detail on each page in our website.

The Federal Government – Medicare is the ONLY place to get Part B Dr Visits. I guess one could argue though that if they have employer coverage available, that would be “Part B.”

Some people might get confused though, thinking Medicare Advantage is giving them their Parts A & B…

The decisions on getting Part D Prescriptions, Medi Gap or Medicare Advantage are separate and give you additional coverage on top of Medicare Part A Hospital and Part B Dr. Visits.

Probably the first decision is if you want a Medi Gap Plan which allows you to go to any MD or Hospital that accepts Medicare, which most do or a Medicare Advantage plan with oftentimes zero premium.

Here’s our web page on helping you make that decision

Our page on how most all doctors take Medicare and if they don’t the limit on what they can charge over Medicare allowance and how if they don’t take Medicare at all, they must have you sign a form that you understand that.

Really high – Here’s a video where I used the Medicare Calculator, but didn’t get a full bottom line answer, yet.

Immigration status and enrollment

To enroll in either Part A or Part B, an individual must either be a U.S. citizen or be lawfully present in the
United States. In most cases, as discussed in detail below, a non-citizen who does not qualify for premium-free Part
A must be a lawful permanent resident (LPR) with five years of continuous residence in the U.S. immediately prior to Medicare enrollment. Justice in Aging Older Immigrants & Medicare

***So, the penalties wouldn’t start till 2017 based on the start of continuous residence of 2012.

More from the Medicare Calculator

You may not be able to get premium-free Part A (Hospital Insurance) based on the work history of you or your spouse (living, deceased or divorced). You can buy Part A for a monthly premium.

If you paid Medicare taxes for less than 30 quarters, the standard Part A premium will be $471.00. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium will be $259.00. Some people pay a higher premium if they don’t enroll when they’re first eligible.

Part A Late Enrollment Penalty

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.

***So they would pay 10% more for the next 10 years.

Part B Late Enrollment Penalty

If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

***So, that would be 50% more.

2021 Part B premium (most people pay this amount)
$148.50

You can get coverage here as a new immigrant besides or in addition to the Bridge Plan.

See this page for the Part D Rx Penalty

It is usually best to keep Medicare Part A and Part B coverage while you are incarcerated. Although Medicare will not cover your care, keeping it will ensure that you avoid late enrollment penalties and gaps in coverage when you are released.

• Medicare Interactive
• incarcerated-and-recently-released-consumers.pdf
• cms.gov/Items-Services-Furnished-to-Beneficiaries-in-Custody-Under-Penal-Authority-Fact-Sheet-ICN908084.pdf

We have a whole webpage on that

• Part D Rx Late Enrollment LEP Penalty Appeals

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c29.pdf

240.2 – Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries

Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:

• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (CMS, the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);

NOTE: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.

• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family;
• A request was sent to a Government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired; or
• Delay due to additional time required to produce the beneficiary’s Medicare documents (such as an MSN) in an accessible format (e.g., large print, Braille, etc.);
• Delay as the result of an individual having sought and received help from an auxiliary resource (such as a SHIP or senior center), due to his or her disability, in order to be able to file the appeal.

Following are examples of cases where good cause for late filing is found. This list is illustrative only and not all-inclusive:

• Beneficiary was hospitalized and extremely ill, causing a delay in filing;
• Beneficiary is deceased. Her husband, as representative of the beneficiary’s estate, died during the appeals filing period. Request was then filed late by the deceased husband’s executor;
• The denial notice sent to the beneficiary did not specify the time limit for filing for the redetermination; and
• The request was received after, but close to, the last day to file, and the beneficiary claims that the request was submitted timely.

42 CFR § 478.22 – Good cause for late filing of a request for a reconsideration or hearing.

Our Medicare Appeals Page

CMS FAQ’s Technical on the process

I don’t like to cite non official sources, but here’s Q1Medicare

Voluntary Termination of Medicare Part B

You can voluntarily terminate your Medicare Part B (medical insurance). It is a serious decision. You must submit Form CMS-1763 to the Social Security Administration (SSA).
You’ll need to have a personal interview with Social Security before you can terminate your Medicare Part B coverage. To schedule your interview, call the SSA or your local Social Security office.

USA.Gov ssa.gov

Form you get back from CMS Medicare when they confirm they got your request to cancel Part B Doctor visits. Note the FAQ’s!

Here’s what was  reported to us in an email about cancelling a pending application for Part B

1) I called the SSA domestic line, waited for half an hour, and was told that the person on that line couldn’t help me because we had an international application. She gave me a number for “international operations” (in Baltimore).

2) I called the “international operations” number and connected directly (no answering machine) to a very helpful young woman who cancelled the Part B application for myself and my wife in about 5 minutes.

3) I strongly suspect that it is policy that you can withdraw an application for which Medicare coverage has not year come into force. In any event, it worked for us.

Steve —

I learned a few things today that I thought I might share with you.

1) Because I enrolled for Part A from abroad (Italy), and declined Part B, I became a candidate to receive an unsoliticed phone call from a US government employee in Rome who handles SS/Medicare issues!! This person wanted to make sure I understood the issues with respect to Part B penalties. This person was very helpful, but knew nothing about MediGap. He didn’t even know what it was.

2) Medicare Part B penalties increment after each full year in which you could have had Part B but chose not to. What then is the date in which you could have had Medicare? You can sign up for Medicare for 3 months before eligibility, and since if you do so your coverage date begins on the first day of the month of your birthdate (unless your birthday is the 1st of the month). For example, if you decline Part B in your initial enrollent period in 2018 but opt for Part B in the first general enrollment period of 2019, your coverage will start July 1, 2019. If your birthday is in July, your full-year penalty clock will start on July 1 and will have traversed a full year. If your birthday is in August, the clock will start on August 1 and it will have been only 11 months … hence no penalty for that year.

Cheers,

Ted W

Living outside the U. S.
(Excerpt copied from publication 11036 Enrolling in Parts A & B)

I live outside the U. S., and I don’t have Part B. Can I get Part B and will I pay more?

It depends on your situation:

Situation #1: If you’re over 65, currently getting Social Security benefits and Part A, and you didn’t take Part B when you were first eligible, (our webpage on eligiblity) (Medicare Eligiblity Tool) you may only apply for Part B during the General Enrollment Period. This period runs from January 1 – March 31, and you may have to pay a late enrollment penalty for as long as you have Part B.

Situation #2: If you live outside of the U.S., you’re over 65, and you’re eligible for Social Security benefits, you may file an application for monthly benefits and Part A. You’ll have to file for Part B during the General Enrollment Period. This period runs from January 1 – March 31, and you may have to pay a late enrollment penalty.

Situation #3: If you’re a U. S. citizen, you’re over 65, you’re not eligible for Social Security benefits, and lived in a foreign country when you turned 65, you must live in the U. S. to file for Part B. You’re first eligible to enroll in Part B the month you return to the U. S. to establish your new residence.

You won’t have to pay a late enrollment penalty if you enroll in Part B when you first return to the U. S. Although you may be able to enroll, in most cases, you won’t be able to get Medicare-covered services while living outside the U.S. Medicare generally can’t pay for any of your hospital or medical bills unless you get your medical care in the U.S. (including Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). Under certain limited circumstances, medical services provided in outside of the United States also may be covered by Medicare, but only if you’re living in the U.S.

Check the Social Security and Medicare Accounts that you must have set up when you enrolled. 

We can help you do that, if you  Set a Meeting – Zoom, Skype