By Susan Jaffe
September 22, 2017
Many older Americans
who have Affordable Care Act insurance policies are going to miss a Sept. 30
deadline to enroll in Medicare, and they need more time to make the change,
advocates say.
A lifetime of late
enrollment penalties typically
await people who don’t sign up for Medicare Part B — which covers doctor visits
and other outpatient services — when they first become eligible. That includes
people who mistakenly thought that because they had insurance through the ACA
marketplaces, they didn’t need to enroll in Medicare.
Medicare officials are
offering to waive those
penalties under a temporary rule change that began earlier this year, but
the deal ends Sept. 30.
On Wednesday, more
than 40 groups, including consumer health advocacy organizations and
insurers, asked Medicare
chief Seema Verma to extend the waiver deadline through at least Dec. 31,
because they are worried that many people who could be helped still don’t know
about it.
They also say more
time is needed because of application delays at some Social Security
Administration (SSA) local offices, where beneficiaries request the waiver.
“We know there are people who can still
benefit from it,” said Stacy Sanders, the federal policy director at the
Medicare Rights Center, a Washington-based advocacy group that coordinated the
request to Medicare. “We know there have been delays, and those are good
reasons to extend it.”
Counselors at the
Medicare Rights Center have helped seniors apply for the waiver in Arizona,
California, Florida, Minnesota, Missouri, New Jersey and New York, she said.
Since the marketplaces
opened in 2014, the focus has been on getting people enrolled, Sanders added.
“There’s no reason to expect that people would understand how to move out of
the marketplace into Medicare.”
The waiver offer
applies not only to people over 65 who have kept their marketplace plans, but
also to younger people who qualify for Medicare through a disability and chose
to use marketplace plans.
The waiver also allows
Medicare beneficiaries who earlier realized their mistake in keeping a
marketplace plan and have switched to ask for a reduction or elimination of the
penalty.
In all cases, people
had to be eligible for Medicare after April 1, 2013.
Officials at the
Centers for Medicare & Medicaid, which runs Medicare, would not provide
details about the number of waivers granted or pending applications. Nor
would they comment on the likelihood of an extension.
Barbara Davis said
that when she initially applied, a Social Security representative didn’t know
about the waiver. She eventually contacted the Medicare Rights Center, where a
counselor interceded on her behalf in June. A day later, a Social Security
representative told her she would not have a penalty.
“My advice would be,
find out your rights before you apply,” said Davis, 68, who lives with her
husband in rural western New York. “Because they don’t seem to want to give you
information to help you, you have to know this on your own.”
A Social Security
spokeswoman said the agency is processing waiver applications from “across the
country” but does not keep track of the number. She declined to comment on
whether SSA employees know about the waiver.
Sanders suggested that
people applying for the waiver ask Social Security officials for it by using
its official name: “time-limited equitable relief.”
Since Medicare’s Part
A hospitalization benefit is usually free, some seniors who liked their
marketplace coverage thought — incorrectly — that they had nothing to lose by
signing up for Part A and keeping their marketplace plan.
Some people receiving
Social Security retirement or disability benefits opted to keep their
marketplace plan and drop Part B after the Social Security Administration
enrolled them automatically in Medicare when they became eligible.
If the temporary waiver
expires, the only other way for beneficiaries to get an exemption is by proving
they declined Part B because a government employee misinformed them.
The groups writing
Verma argue that keeping the waiver in place past Sept. 30 could also help many
beneficiaries who may be surprised by a little-known rule that will affect 2018
marketplace policies.
For the first time,
insurers will be prohibited from issuing a marketplace plan if they know the
member is eligible for Medicare and the 2018 policy is significantly different.
Those who find
themselves without a marketplace plan could be in for another surprise: They
won’t have insurance for outpatient care until July 1 because Medicare imposes
a waiting period before Part B coverage kicks in for latecomers.
Extending the deadline
“would lessen a significant hardship for many people … [who] are unaware of the
repercussions that could result from keeping their marketplace coverage,” said
Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an
industry group.
For information on how
to apply for the time-limited equitable relief waiver, go to the Medicare
Rights Center’s Medicare Interactive webpage or
call the center’s helpline at 1-800-333-4114.
This story was
produced by Kaiser Health
News, an editorially independent program of the Kaiser Family Foundation.
Susan Jaffe: Jaffe.KHN@gmail.com,
@SusanJaffe
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