From a report by Social Security’s Office of Inspector General:
SSA and the Centers for Medicare and Medicaid Services share administrative responsibilities for Medicare. …
SSA enrolls beneficiaries, establishes applicable premium penalties, and collects premiums from individuals who receive Social Security benefits. If an individual signs up for Part B after their Initial Enrollment Period, they may have to pay a late enrollment penalty.
We identified 101,516 OASI beneficiaries who enrolled in Part B during the 2023 and/or 2024 General Enrollment Periods and whom SSA penalized for late enrollment. We reviewed a random sample of 200 of these beneficiaries.
SSA employees accurately processed 177 of the 200 Part B applications we reviewed. However, SSA employees did not accurately process the applications for the remaining 23 beneficiaries. As a result, SSA’s systems improperly assessed approximately $24,000 in Part B premium penalties.
Based on our sample results, we estimate SSA employees accurately processed approximately 90,000 beneficiaries’ applications and did not accurately process 12,000 beneficiaries’ applications. As a result, SSA’s systems improperly assessed about $12 million in Part B premium penalties.
These errors occurred because SSA employees did not consider Group Health Plan coverage, the impact of U.S. residency and lawful presence start dates on Initial Enrollment Period determinations, deemed enrollment, Exceptional Conditions, Special Enrollment Periods, and equitable relief. …
What I’ve seen over the years is that you can almost always find a legitimate way to avoid the late enrollment penalty. I don’t know why they even try to apply a penalty. It’s not worth the trouble.
5 comments:
Wild. I just posted a comment about this also being a big issue yesterday in the thread about Windex errors.
Anyway, yeah. Just get rid of penalties across the board. Just let people get medicare.
The “why”, of course, is that the law requires it. The rationale for the provision is, of course, creating the largest risk pool possible by eliminating a way for the healthy to game the system.
We don’t go out of our way to “apply” the penalty. If the system sees no coding for proof of a group health plan, it’s automatically applied. No extra effort required by the adjudicator. It’s because the information we need is missing.
There is/was a flimsy online portal for Part B filing only. It tells claimants to submit proof of coverage and many submit copies of their insurance cards. However, many of these cards don’t have coverage START dates. We call the claimant and either they don’t pick up or yell about how they don’t have to submit anything because they filed online (they believe the call is a scam). The employee adjudicates the claim and boom… penalty.
They need to do a much better job communicating what the penalty is all about! When I went on disability, I could not afford Part B so I dropped it. I was on the Free Care Program in Massachusetts and did not really need it as all of my doctors were at a Community Health Center. Many years later I learned of the consequences but it would have been nice if someone told me???? That was over 20 years ago and now am on Medicaid. When I turn 65 I will qualify for it for another reason- being 65 and I get a "restart" with my full retirement not being until 67. So, when I am 65 I need to buy it this time to avoid another penalty period. These are the things no one tells you...
Also, there is a huge lack of knowledge about exceptions, especially how being eligible for Medicaid solves the problem. See post immediately above. That is separate from the reset at 65. To be clear, if you are eligible for the Buy-In (cost sharing), that is a Medicaid program and exempts you from both the pnealty and the delayed enrollment
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