Mr. T had health coverage through his wife but had to pay a Part B premium penalty when he enrolled in Part B after she retired.

Mr. T has a disability. He enrolled in Part A 20 years ago, but declined Part B because his wife was working for a company that provided him with health insurance coverage. Soon after his wife retired, Mr. T went to his local Social Security office to sign up for Part B. A representative at Social Security told him that its records showed a five-year gap in his employer group health coverage. Mr. T was told that he would have to pay a premium penalty for the five years and wait to enroll into Part B. Mr. T did not believe this was accurate, since he was covered by his wife’s employer insurance continuously.

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Social Security said that Mr. H missed his Part B Special Enrollment Period.

Mr. H has a disability and had Medicare Part A. He had health care coverage through his wife’s employer insurance, so he did not enroll in Part B. In November of 2011, Mrs. H stopped working, but kept her employer coverage. Mrs. H did not return to work, so her employer coverage ended in May 2012. Mr. H applied for Part B coverage in August of 2012, but his application was denied. Social Security said that Mr. H was outside his eight-month Special Enrollment Period because his wife ended her active employment in November 2011. Mr. H would have to wait for the 2013 General Enrollment Period, and his coverage would not begin until July 2013.

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Mr. C became eligible for Medicare but declined Part B.

Mr. C had been receiving Social Security Disability Insurance (SSDI) for 24 months and became eligible for Medicare in December 2012. Mr. C enrolled in Part A but turned down Part B because he felt he could not afford the Part B premium. Soon afterwards, Mr. C realized that without Part B he would not have coverage for his doctor’s visits. He went to his local Social Security office to enroll in Part B in early January 2013. However, when Mr. C received his Medicare card, it stated that his Part B coverage would not begin until July 1, 2013.

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Mr. D was denied coverage for non-emergency ambulance transportation.

Mr. D recently returned home after being hospitalized with a number of severe medical conditions, including end-stage renal disease. Mr. D requires dialysis three times a week. His family contacted a local ambulance company to request regular appointments for transportation to the dialysis facility, because he is confined to his bed. The family also forwarded a letter from Mr. D’s doctor stating that this transportation was medically necessary because Mr. D needs medical services during your trip that are only available in an ambulance. However, the ambulance company refused to transport Mr. D because it said that Medicare would not pay.

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Mr. D was worried that his father-in-law might need Part B to cover rehabilitative care in a nursing facility.

Mr. D’s 82-year-old father is still working and has insurance through his job. So, he turned down Medicare Part B. He did enroll into Medicare Part A. He was recently hospitalized and then sent to a skilled nursing facility (SNF). Mr. D discovered that his father’s employer policy had very limited coverage for SNF care. Mr. D became concerned that his father would need Part B in order to get the care he needed.

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Mrs. B’s gynecologist did not accept assignment and refused to bill Medicare.

Mrs. B’s gynecologist took Medicare but did not accept Medicare assignment. Doctors who do not take assignment do not have to accept Medicare's approved amount as payment in full. They can charge up to 15% above the Medicare-approved amount for their services. They can also ask their patients to pay for services up front. Mrs. B was paying her gynecologist up front. Medicare had never reimbursed her for the service. Mrs. B called Medicare to find out why she had not been reimbursed and found out that her gynecologist had never submitted a bill to Medicare.

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