Mrs. H is about to turn 65 and has never worked. She needs Medicare because it will be her primary insurer when she turns 65. Her husband, Mr. H, is 58 and retired. Mr. H worked in the United States for over 25 years. Because of his age, he is not yet eligible for Social Security benefits.
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.
Ms. M had an employer group health plan as her primary insurance and Medicare Part A as her secondary insurance. Ms. M was laid off and became eligible for COBRA through her employer. She wanted to know how COBRA works with Medicare.
Mr. N is 50 years old and had Medicare Part A due to a disability. He declined to take Part B because he had his primary insurance through his domestic partner, who worked at a company with more than 100 employees. Recently, his domestic partner found a new job. When Mr. N tried to enroll in Medicare Part B, during his Part B Special Enrollment Period (SEP) Social Security told him he was not eligible for a Special Enrollment Period because his insurance came through a partner, not a spouse. He was also told that he would have to wait to enroll until the next General Enrollment Period (GEP), which goes from January through March of every year with coverage beginning in July.
Mr. B turned 65 in December 2011 and retired from his job in August 2012. The month after he retired, a friend told him that he missed his chance to enroll in Medicare and would have to pay a big penalty.
Ms. B has oral cancer and needs radiation therapy to treat it. Her teeth are not healthy, and her doctor wants take them out because they may become infected during the treatments. Her doctor told her she would need dentures before her radiation treatments so she could eat and maintain her health. Medicare covered the cost of removing her teeth but denied her coverage for her dentures. Ms. B could not afford to pay for them herself.
Mr. S enrolled in Medicare Part A when he turned 65 and was told by an 800-MEDICARE representative that he did not need to enroll in Part B at that time since his wife’s retiree plan sufficiently covered his needs. He assumed he could enroll in Part B without penalty when and if his wife’s retiree coverage ended.
When his wife’s retiree coverage ended, he tried to enroll in Part B. Social Security informed him that he would have to wait to enroll between January and March during the General Enrollment Period and be without Part B coverage until the following July. He would also have to pay a premium penalty for late enrollment.
Ms. Z was a patient at a skilled nursing facility (SNF) for 100 days to treat a broken hip. She was discharged from the SNF after 100 days because she had run out of days in her benefit period. However, 20 days later she broke the other hip and was admitted to the hospital. She wants to know if Medicare would cover the SNF care she would need after she was discharged from the hospital.
Mr. F has Original Medicare Parts A and B. He was in a Department of Veterans Affairs (VA) hospital. After three weeks in the hospital, he wanted to transfer to a Medicare-participating hospital closer to his home. Since VA facilities do not participate in Medicare, Mr. F did not know if the transfer would create any coverage problems.
Ms. B was receiving Supplemental Security Income (SSI) and had Medicaid when she became eligible for Medicare. A Medicare representative told her that Medicaid would automatically enroll her into a Medicare Savings Program (MSP) and that the program would pay her Part B premiums. However, six months later, she received a letter from Social Security informing her that her Part B benefits had been terminated because of non-payment of her premiums.