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.

What To Do:

Mr. T requested documentation from his wife’s employer group health plan certifying that it had been his primary health insurance coverage during the five years in question. With this evidence, Mr. T appealed Social Security’s decision that he owed a Part B premium penalty. Mr. T won the appeal and was reimbursed for the premium penalties he had already paid. For more information on when to enroll into Medicare Part B, please click here.

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