THIS COLUMN IS going to be about health insurance, and it’s going to be pretty technical.
What I’m going to go on about won’t touch everyone but if it touches you or someone you care about, it could have a pretty happy effect on your finances, so please stick with me at least for a little while.
First, the Medicare piece: I think most of us know that Medicare Part A (think, hospital) is generally free for most of us, most of the time.
Medicare Part B (think, doctor), on the other hand, has a monthly premium, and I think we’re generally aware that if we don’t enroll in Part B when we’re eligible, we get slapped with a penalty when we do finally enroll, and that penalty follows us around for the rest of our Medicare-haunted lives.
OK. Now the Obamacare (aka, Affordable Care Act, ACA, Exchange or Marketplace) piece: A lot of folks who were not getting employer-paid health insurance and were too young to qualify for Medicare purchased health insurance coverage through the Exchange, as it’s known in Washington state.
Based on their income and circumstances, some of these folks might have received premium tax credits or income-based cost-sharing reductions that made those Exchange policies more affordable.
Time marched on, as it tends to do.
So, when folks became eligible for Medicare Part A (usually, by virtue of age, but it could also have been via disability), they said, “Sure. It’s free, so why not?”
OK, but then they realized there was a premium for Part B, and that Part B premium was more than what they were paying for their Exchange-based policies, particularly if they were getting tax credits, etc., so they said, “No, thank you,” and stayed with their cheaper Exchange coverage.
It kind of makes sense, right?
Wrong. You can’t do that.
That being have an Exchange-based policy if you’re eligible for (or have) Medicare, and because these folks had Part A, bam. What happened?
Well, first they lost their Exchange policy, then they either enrolled in Part B with a penalty or had to just skip Part B altogether. And that’s scary.
So, is this just an interesting bedtime story or is there actually a point to all this?
There is a point and here it comes.
CMS (Centers for Medicare and Medicaid services, aka the feds) has extended what they call “equitable relief” for folks in the situation I’ve described above.
This has been around for a while, and I’ve talked about it before, but it was due to expire.
Now this has been extended through Sept. 30 so if this sounds at all like you to you, I hope you’ll jump on it.
Stop.
This has nothing to do with politics, nor does it have anything to do with our collective ability to read tealeaves to divine the future of the Affordable Care Act.
This has to do with individuals who are in this situation right now, and could use some help with day-to-day household budgets, so if they can (a) get their Part B, and/or (b) get it for less money, they are better off than they were.
So, what is this “equitable relief?”
Allow me to quote CMS: “CMS is offering assistance to certain individuals enrolled in both Medicare Part A (and/or Part C) and the Exchange for individuals and families to drop their Exchange coverage and enroll in Part B without penalty.
“Further, CMS is offering assistance to certain individuals who dropped or lost their coverage from the Exchange and are paying a penalty from their subsequent enrollment into Part B.
“These eligible individuals can have their penalty reduced.
“Individuals can apply for the special enrollment and reduction in late enrollment penalties during a limited time — it is available now and ends Sept. 30, 2018.”
What do you actually do?
Well, you call Social Security at 800-772-1213 (TTY is 800-325-0778) or go into a Social Security office, and request to take advantage of this offer.
Ask for “equitable relief” when you request Part B enrollment or penalty removal, and mention that you were “dually enrolled in Medicare free Part A and the Exchange,” and you’re going to want to have some documentation that you actually were enrolled in Exchange coverage, so bring premium invoices, IRS Form 1095-A or something that says you actually had that coverage.
I’ve just told you everything I know about it.
I can try to field questions, if you have them, but the fact is, I’d be guessing.
If it were me, I’d find that documentation of Exchange coverage, take a deep breath and call Social Security, remembering to be friendly, patient and polite.
Good luck.
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Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing harvemb@dshs.wa.gov.
