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.

What To Do:

Mr. H called his State Health Insurance Assistance Program (SHIP) and found out that his wife’s current employment status did not end in November, when she stopped actively working, but in May. You can have current employment status if you are not actively working as long as you retain employment rights at your company. Whether or not you are being paid by your employer does not matter. Mr. H appealed Social Security’s decision. His August Medicare application was found to be within the Special Enrollment Period, and he was enrolled in Medicare Part B retroactive to September 1, 2012.

For more information on when to enroll into Medicare Part B, please click here.

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