Help with Medicare?

[AirmensMom]

It doesn't look like this group is very active, but I'll try anyway.

I am disabled and became eligible for Medicare years ago. However, I opted out of Part B because I was covered under my husband's employer's group plan. His most recent employer closed up shop suddenly and unexpectedly in January, causing us to lose our group coverage. He signed up on healthcare.org, but I am not eligible to do that because I am disabled and eligible for Medicare.

I immediately went to my local Social Security office, which takes applications and faxes them to Social Security, to apply for Medicare Part B. After waiting 3 months, I called the national number on Monday and was told that my application was denied. The only reason given was "not an enrollment period" and was told to re-apply. When I called the local field office, they said I need to appeal.

It was my understanding that I am eligible for a special enrollment period because I have maintained group coverage all these years and lost coverage unexpectedly. There is a form to be filled out by the employer stating this. I was able to get the form from the most recent employer, but could not get one from the previous one because they had been bought several times during the course of my husband's employment and the final buyer/employer does not keep employee records that far back. Social Security advised me to submit letters of creditable coverage from the insurance companies, which I did. There was no gap in coverage at any time.

As fas as I can tell, I did not do anything wrong. But they never sent a letter of denial or information on what they need. I have been without healthcare, except for Medicare Part A, since February 1 and have since run up some bills at some Doctor's offices. Now it looks like it will be another 3 months, after a I figure out what I need to do, before they will start coverage and hopefully backdate it to February. Even if they do that, I could be charged a stiff penalty if they don't accept the letters from the instance companies as proof of group coverage during all that time.

Does anyone know what to do? It's not like you can talk to anyone who makes the decisions. I wish they would just pick up the phone and call if they see a problem, rather than inefficiently requiring another long process involving paperwork and lots of calls to the call center.

On a side note, this is a perfect example of why Republicans hate government. Yes, I have Republican friends who could only reply, "yeah, that's the government for ya" when I told them about it. It would be great if we could do something to streamline this process, as well as all the other processes that seem to be so bogged down in bureaucracy that they waste a lot of taxpayer money.

[Human101948]

1. Sorry for the difficulty you are experiencing...

but this is another example why we should have a national health care system that covers everyone from cradle to grave.

[AirmensMom]

2. I agree.

The funny thing is that when I login on Medicare.gov, I can see all the insurance companies listed under the Primary Insurance tab. But the Social Security Payment Center never talks to Medicare, apparently, or the would have already known I had coverage without all that paperwork.

I want a national healthcare system more than anyone knows. Even with Obamacare, the deductible is so high and the providers are so limited that we are in fear of either one of us getting sick during this awful time.

[floriduck]

3. And for people requiring a lot of medical care, the donut hole is a killer.

Why did the ACA not require it to be closed? Senseless!

[AirmensMom]

4. I can't answer that.

Except that ACA wasn't what we needed. It is better than nothing but not nearly good enough. Medicare for all isn't the answer either, unless someone can figure out how to get people signed up efficiently and make supplemental insurance/gap policies unnecessary.

[PoindexterOglethorpe]

19. It is my understanding that the donut hole

is in the process of being eliminated.

[JustABozoOnThisBus]

5. It certainly sounds like you're eligible, after being covered by a company group plan.

I had to get a form filled out by my wife's company's H.R. department after she retired, proving that I was covered. You may not be able to do this, since the company closed.

Maybe there's a local legal aid group that can give you some advice?

[AirmensMom]

6. Thanks.

We got that form for the latest employer, from 2009-2016. The other one was swallowed up 3 times, eventually by intel, who told us to pound sand.

Everyone I spoke to at the local and national Social Security offices said the same thing, that Inam eligible... Except for the lady at the national office who told me I was denied. She then lectured me about how I WAS covered but CHOSE to reject the coverage and didn't I know I had to maintain group coverage? **sigh** I did everything right and still am getting the shaft.

Not aware of any legal aid groups, but I'll see if I can find any. Thanks for the suggestion. A friend knows a lawyer. We are doing all we can to stay above water and can't add legal bills, so that will have to be a last resort.

I was going to write to my state rep, but he states on his website that his first priority is to repeal Obamacare. Even if I could hold my nose and do it anyway, it's not like there's a phone number ... Just fax all my personal information, including Social Security number and all application forms to an unknown fax number and maybe he'll get around to it. Not likely!

[NV Whino]

7. I can almost guarantee you coverage won't be backdated.

As for just getting coverage to start with, the sqeaky wheel approach is the best. Deluge them with letters and phone calls. Send the same stuff over and over. Ask to speak to the supervisor and then the supervisor's supervisor.

Also, check your local listings for advocates or omnibudsmen who can help you through this. They know all the tricks and know who to call to get things done. Your SS office may be able to give you some names.

[AirmensMom]

8. How do I speak with the supervisor?

I asked for one and was told there is no one else to talk to. I am good at being a squeaky wheel. Maybe I'll hold on the line for another hour today and try again. Thanks!

My local Social Security office has so far been useless. They said even they can't talk with anyone ... Just some sort of communication line via DOS at may or may not get a response within 3 months.

[NV Whino]

9. Call back

You will get another person, then ask for the supervisor. Make sure you write down names. There is probably an Internet listing of personnel for the company. That might help you get to the right person faster.

I bought my insurance through an agent. When I have run into problems, he is the one who has to make all the calls.

[AirmensMom]

10. On wait now.

Estimated wait time is 33 minutes. I'd like to speaks with the sadist who invented musical holds.

[NV Whino]

11. I wish you good luck and patience.

[AirmensMom]

12. Thank you.

If they don't approve and backdate, this will be my first lapse in coverage since 1978. Makes me nervous about how the next employer's group plan will wiggle out of covering my pre-existing conditions. We haven't switched plans since ACA went into effect.

[AirmensMom]

17. Good news!

Approved and backdated, with no penalty. They accepted W2s, pay stubs, and EOBs for some of the years, with no explanation of why they weren't good enough for the others. We were finally able to get forms signed and it went smoothly after that and was approved within a week. Two of the men at the local SS office were very helpful, while the woman who originally took my application was pretty useless from the start. It matters which SS or HR rep you get.

[NV Whino]

18. Good news indeed

I'm happy to have been proven wrong.

[AirmensMom]

13. Update

So yesterday I waited on hold for about 35 minutes before Devon in Baltimore came on the line. I immediately asked for a supervisor, but he refused to get one until I told him my information. Then he put me on hold for several minutes and then came back and said all the supervisors were in a meeting. So I told him the whole story, he looked at my file, and sure enough, no letter has been generated but the application was denied. He put me on hold again and again came back saying the supervisors were still in a meeting. He took my number and said he'd leave a note on his supervisor's desk asking him to call me and assured me that his supervisor always makes those calls. Well, the callback was supposed to happen yesterday or this morning. Stupid me, I believed him. No call, of course.

I called the local office again today. They were supposed to get back with me "in one or two days" from Monday. They at least had more info. Turns out that Social Security DOES NOT accept letters of creditable coverage from an insurance company. Now they want W-2 forms, Explanations of Benefits, Insurance Cards (does anyone keep old insurance cards?), and likely my first born. Fortunately, I had the W-2 forms and Explanations of Benefits. I'll deliver them tomorrow and we'll see what happens. I was assured that it will not take another 3 months to have this reviewed. We'll see about that.

Social Security needs to get into the 21st century. The requirement for that one form is ridiculous given the current business climate where companies buy up other companies to get rid of the competition. There is no one is left at the original company to complete the forms and the new company claims to not have old employee info. I was told that letters of creditable coverage from insurance companies are legal documents ... but somehow Social Security doesn't see them as such, even when they have both my name and my husband's name on them, the dates of coverage, both Social Security numbers, and the employer's name on them.

I just hope I don't have a heart attack or stroke before this damn thing is settled.

[csziggy]

14. Try contacting your Senator's or US Representative's office, too

Often they have staffers that can cut through red tape though it depends on whether or not the people who are in office cares.

You can probably go through a link on their government page to send a request for help. Start here: https://www.usa.gov/elected-officials

[AirmensMom]

15. Can't call.

Their instructions are to write or fax with all the application materials. Oh, and you have to sign a waiver first. It's just another black hole and all my reps suck anyway (all Republicans). I looked into it about a month ago and revisited it this week. I'm hoping the stuff I take to Social Security tomorrow will help. Also, husband is bothering Intel again. I think he found someone a little more helpful today who is going to do some research to see if we can get the form completed, but we won't hear back until next week.

Anyway, thank you for your suggestion. I did write to President Obama. Feels sort of silly because I'm sure he has better things to do than make sure signing up for Medicare is actually possible, especially when you're locked out of coverage through healthcare.gov.

[AirmensMom]

16. Another Update

I took all the info to the local office on Friday. I got a different rep this time, but he was familiar with my case. He said he would send in the info, but the problem is this: It doesn't matter that I can prove that I was covered by group insurance. It doesn't matter that I can prove, through pay stubs and W-2 forms, that my husband paid for that group insurance. It doesn't matter that I have EOBs that identify the company he worked for and used his insurance to pay my bills. They want that form. Period. It's the law and is not flexible.

Meanwhile, he can get me started with enrolling during the General Enrollment Period, which starts in July. I will be paying almost $300/month instead of $122-something until I turn 65, but at least I'll be covered. And we can still fight the good fight to get them to recognize that I have fulfilled the requirements, backdate until February 1, and pay back any penalties they charge me. That could take several months.

So we tried again with the final company who did all the purchasing of the other companies and got a nice lady who agreed to research employment records. She found records going back to shortly after the first company purchase, which is helpful, and will fill out the form for the years she can find records for. That leaves 2 years unaccounted for, from the original company. We might be able to find the HR guy from back then to fill in the gap, as my husband is still in touch with most of his colleagues from back then. Wish me luck.

A word of advice: If you are disabled and on a spouse's group insurance, get form CMS-L564 filled out every time s/he changes jobs or his/her company gets bought and keep them in a safe place so you don't have to go through this. The letters from the insurance companies that are generated automatically will not help.