Mar 2, 2017

Some Relief For Confused Claimants Because "Nobody Knew Healthcare Could Be So Complicated"

     From Emergency Message EM-16033-REV:
This emergency message (EM) provides instructions for handling Medicare Part B (Supplementary Medical Insurance) enrollment requests from beneficiaries with Medicare Part A (Hospital Insurance) who also are or were enrolled in an individual Marketplace plan. It also contains instructions for Part B premium surcharge rollback for certain beneficiaries with both Medicare Part A and Part B who have or had Marketplace coverage.
Coverage under Medicare Part A meets the legal requirement for minimum essential coverage. Individuals with Medicare Part A are not eligible to receive premium and cost-sharing assistance (often referred to as advanced payments of the premium tax credit (APTC) or income-based cost sharing reductions (CSRs)) to help pay for a Marketplace plan premium and covered services to make the costs of a Marketplace plan more affordable. Individuals receiving APTC while dually-enrolled in coverage through the a Marketplace and Medicare may have to pay back all or some of the APTC received for months an individual was enrolled in both Marketplace coverage with APTC and Medicare Part A when they file their federal income tax return.
Some people may have had coverage through the Marketplace (and possibly received APTC or CSRs) before being eligible for Medicare. When first eligible for premium-free Medicare Part A, these individuals may have refused or dropped Medicare Part B coverage because the costs for Marketplace coverage, with any financial assistance they may have been receiving, was more affordable than Medicare Part B, and they believed they were eligible for APTC and CSRs. In addition, some people with Medicare Part A coverage may have enrolled in coverage through the Marketplace believing it was an alternative way to get medical coverage equivalent to Medicare Part B at a more affordable cost. These individuals may not have found out they were not eligible for APTCs or CSRs or not learned about the coverage rules prior to the end of their Medicare Initial Enrollment Period (IEP), resulting in them either 1) declining to enroll in Medicare Part B at all; or 2) enrolling in Medicare Part B during the General Enrollment Period (GEP) and being assessed a Medicare Part B late enrollment penalty.
CMS [Centers for Medicare and Medicaid Services] believes that many of these individuals did not receive the information necessary at the time of their Medicare IEP or initial enrollment in coverage through the Marketplace to make an informed decision regarding their Medicare Part B enrollment. ...
Equitable relief will be considered on a case-by-case basis for certain dually-enrolled beneficiaries (those who have or had both Medicare and Marketplace coverage) of any age who refused or dropped Part B and for those who subsequently enrolled in Part B during the 2015, 2016 or 2017 GEP. 
Beneficiaries who refused or dropped Part B may receive equitable relief in the form of an enrollment opportunity with an effective date outlined in Section E of this instruction. The ability to provide the enrollment opportunity under equitable relief is limited to Part B enrollment requests received from September 1, 2016 through September 30, 2017. No late enrollment penalty will be applied for individuals who enroll in Part B under this limited equitable relief. ...
     By the way, I had clients who asked about declining Part B for this reason and I told them not to do it. I can't think of a reason to decline Part B other than getting all of one's healthcare from the VA (and being happy with it) or living outside the U.S.
     Also, by the way, I can just imagine a Trump transition team member trying to review this Emergency Message and being completely befuddled by it. As President Trump said, "nobody knew healthcare could be so complicated."


Anonymous said...

Retirees should always consider contacting the local SHIP (Senior Or State Health Insurance Program)via the local Area Agency on Aging. These folks are trained to provide assistance and information about the healthcare choices for those new to Medicare. They can assist with choosing a Part D Plan, complete the LIS if needed, review coverage with Medicare Advantage Plans in the area and discuss Medicare Supplemental Insurance. They are not associated with any insurance company, but funded by the Older Americans Act, so they do not get a commission for putting someone in a plan. The service is normally free, but due to many state budget cuts to social services they may suggest a donation. has a very easy to use locator search.

I am shocked that more representatives are unaware of the services available to those they get benefits for. ALL of them should be aware of the local SHIP and CIL (Center for Independent Living) so the Claimant has an opportunity to get assistance once benefits are established and the Medicare IEP is available. But I guess once the check is in the bank, that's all that matters to some.

Anonymous said...

You couldn't just leave it as an informative public service announcement could you... had to include the pious backhanded insult to those of us earnestly working with our clients.

Maybe some are simply unfamiliar with the program.

No kudos for you!

Anonymous said...

Your attitude is just what I expected 2:19, the last thing in the world I need is your kudos. Now you are informed, perhaps you can become educated, obviously you cannot use Google or have ever even attempted the assistance outlined above or it would have been so entirely basic as to be worthless.

So I stand by my original statement.

Anonymous said...

that's right 9:47/5:06, take a jab at people under the guise of informing the public and then continue to show a disdain-filled attitude in your response...yeh just keep digging your heels in the quicksand.

so admirable to stand behind your original statement....despite the tone deafness you continue to display.

what a boorish pill.

Anonymous said...

We truly are a divided nation

Anonymous said...


Why would you think that the reps would know about this program?

Why the statement about the check in the bank?

Why do you hate reps so much?

Do you know everything about everything?

Your negativity is a reflection on you, not on the reps that you seek to disparage.

You have my pity whether you want it or not.

Try to be nicer to yourself and perhaps you will learn to be nicer to others.

I wish you well.

Anonymous said...

Reps really should know that basic information.

Anonymous said...

@6:17, must be hitting a little to close to home for you. Have a nice day!!!

Anonymous said...

@6:17 I am interested in why I am "digging my heels into quicksand" as you put it. There will never be a shortage of aging and disabled people needing assistance. With 10,000 people reaching retirement age every day for the next 25 years or so, I would say that there will be a steady stream of individuals needing the services, information and programs I work with. As we see a shift in the views of the national leaders we have seen a decline in approvals for programs like SSDI. Recent discussions on block grants to programs like Medicaid mean that those that provide services to communities are going to come into play more often as state and federal programs will not be paying for base services and goods.

Community service members and networks that work with the aging and disabled have long been developing equipment loan programs, food services, training and other programs to keep the aging and disabled in their homes, where it is cheaper for the state, better for the individual and stronger for the community.

I am a boorish pill, I am also able to find that pill on a Medicare Part D Plan Finder, complete the LIS if needed, do a cost analysis of the plans for the consumer and connect to other programs to get that pill at a price the Claimant can afford. I can also direct them to a food pantry to get some sugar to help the medicine go down, see if they qualify for MOW (Meals on Wheels) home healthcare assistance, a connection for rides to the grocery or doctor appointments. If the representative is truly in the business to provide assistance to the disabled, the representative should be aware of the programs and providers in the area. I have only seen groups like Allsup coming to the networking meetings and they are pitching the services they charge for and get a kickback on the Medicare plans they sell. Not one local representative of SSDI has shown up in 10 years I have been providing services. It is not our job to reach out to professionals and inform them, but for the professionals to reach out to become informed about an area of importance to their clients.

We may have differing opinions, but I voiced my opinion in a manner that did not involve name calling. If you wish to continue the discussion I encourage it, but would ask that you do so in respectful and professional manner.

Sincerely, a boorish pill, in disdain, and quicksand up to my neck!

Anonymous said...

I also want to add that I do not expect representatives to be able to provide all of those services, but I do expect them to know where the services are and provide the contact information to the Claimant.

Anonymous said...


You are so quick to condemn the reps, but you only know about these services because it is part of your job AND you must have been provided with some training.

Providing these services is not part of the reps jobs, although I bet that if training was provided, more of them might get involved in it.

You only pointed out negatives, why don't you see it as an opportunity to provide training for the reps instead of treating them like the enemy.

Anonymous said...

1:01, I clearly stated I did NOT expect the reps to provide the services, only be able to refer the Claimants to the services. Again and again on this blog we see reps posting that they do this line of work not for the money but to help those with disabilities. If you are going to take that moral high ground then how could they practice multiple years and not know of those most basic services for the disabled? They do not know because they do not participate with disabled in the community other than as clients. It would behoove them to provide those agencies to the Claimant during the process to aid with medication, medical payments and more. Many urban areas have 211 services for information and referral to agencies, it is advertised on radio and television. If you are truly in it for the disabled then become informed to the agencies and services in the area, if not ignore this and be upset. Every CIL and AAoA is listed in a variety of resource guides, provide dozens of trainings a year, do in service training to community business, and hold public health and information fairs. They also are constantly fund raising to make up funding gaps. Funny how the disabled clients find the services but the educated representative of the disabled is unaware the programs are even out there.

I do not treat them like an enemy, I don't treat them at all because we don't ever see them.

Anonymous said...

I think your point is well taken. We are professionals in a service business and for some a calling. I am attracted to the work because I grew up with a blind and disabled mother. My office has even assisted in getting one of our mentally ill clients who passed away and was a veteran a funeral and burial in a military cemetary. However, I can tell you this since the NPR and other media slam attacks and the DC witch hunt declared by the powers out to get the program and the congress, I feel like I have been designated for extinction. It is getting much harder to do this social work and feed a family and keep an office open if you are truly in this field for the right reasons. I have also gotten to see my clients starve out and die off in greater numbers since 2010 from their ailments or suicide. I can tell you the names of everyone I've lost. We are promised an Ayn Rand utopia if we just get rid of all of the lawyers. What I have seen is injured workers in state comp systems getting totally screwed due to "comp reform" and my clients suffering far more than ever due to the hostile climate which has been stirred up against them. Get rid of us and it will be open season on claimants. Fill up those private prisons and let the rest die from neglect. This is not the nature of a civilized society that I would wish to live in. Remember, totalitarian societies trash and lock up the lawyers. Wonder why?

Anonymous said...

They lock us up because we persist, regardless of our gender.

Anonymous said...

Amen! If our democracy is to be preserved we must persist.

Anonymous said...

While you are persisting you might try getting off your whiny butt and do something.

Anonymous said...

Kiss my whiny ass 11:57.

Anonymous said...


What are you talking about?

You clearly hate attorneys and it appears to be a simple case of JD envy.

Go get your law degree and put the rest of us to shame.

Otherwise, by all means continue to exercise your first amendment right to express your opinion, but realize that if it wasn't for lawyers, that right would most likely have been severely abridged by now.

Once again, you have my pity whether you want it or not.

Anonymous said...

The poster said get off your butt and do something and is accused of JD envy, whatever that is and to to eff off. Nice professional responses to a call to action. Sure hope the poster is a JD too and passed the bar and was calling his brothers and sisters to arms. I lost a lot of respect for the board on this.

Anonymous said...


1157's comment was a slam against attorneys, plain and simple.

It was not a call to action, however, you get extra points for imagination.

Attorneys persist everyday fighting for other people. Are there some bad apples? Yes there are and they make us all look bad. However, the fact that there are some bad attorneys does not warrant the downright animus that the non-attorneys on this board and in the Agency have for attorneys.

But I am breaking my own rule and feeding the trolls.

Anonymous said...

Do not advise your clients to cancel your Part B if they have VA coverage under Tricare for Life.

Tricare cancels you until you get back under Part B. Which you can't get until the next general enrollment period (Jan-Mar). And coverage doesn't start until July.

There's a reason we try really, really hard to talk people out of cancelling Part B at the field office in situations like these. Because we usually see the same people a short time later, and they just came back from the VA pissing in their cornflakes, claiming we told them wrong.

There's a reason we make you sign a 795 stating we advised you not to at the same time we give you the 1763 to cancel...........

Anonymous said...

@7:34 They teach you that at Harvard? remember, non atty reps are doing your exact same job and getting paid the same thing. Bless your heart!

Anonymous said...


Its official, you are exhibiting the classic signs of JD envy.

Anonymous said...

While the children are busy tussling in the sandbox, here is some information for the professional, semi-professional, Claimant or other concerned parties:

National SHIP Office Locator for Medicare and Medicaid assistance, aging and disability related services.

CIL (Center for Independent Living) Locator
Assistance for those with disability to stay living in the community, training, equipment loan programs, program assistance, and more.

ACA Navigator Locator (Obamacare for those who know it that way)

ADRC (Aging and Disability Resource Centers)

If you are seeking additional resources, post here, likely others have similar questions and problems.

Anonymous said...