Medicaid mistakenly failed to pay Ms. B’s Medicare Part B premiums.

Problem:

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.

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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.

Problem:

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.

Problem:

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.

Problem:

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.

Problem:

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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