UNITED STATES─ Reader Alert: Many company benefit plans terminate the day you are no longer working full-time. Explore you or your spouse’s group medical plan rules and options with Medicare if you are 65 or older.
Morning Toni: My wife and I desperately need your guidance because last November, I was rushed to the ER because of kidney failure, which was caused from stage 4 of prostate cancer that had spread to my pelvic bones.
Because I was working full-time, I took a leave of absence with company short term disability on November 15 for 60 days while receiving my cancer treatment. Short term disability ended on January 15 and I was placed on Long Term Disability.
I was informed via a phone call to my hospital room at MD Anderson that I had qualified for long term disability and would no longer be part of the company’s health plan since I was no longer working full-time. COBRA would begin immediately.
My wife and I enrolled and paid for COBRA, so that I could continue with medical care from MD Anderson. It took 6 weeks to get the paperwork to Social Security for me to enroll in Part B, since I was not working full-time and my Medicare Part B began March 1.
My COBRA nightmare is beginning… because COBRA is only paying the 20 percent of medical/doctor bills and I was billed the 80 percent since I was not enrolled in Medicare Part B when Long Term Disability began. Now I owe $40K. What do I need to do? Thanks, Rob Cypress area.
Rob: Those reading this article need to realize the seriousness of Medicare and insurance rules especially when no longer working full-time and receiving Long Term Disability due to a serious illness and enrolled in COBRA
The Medicare & You handbook discusses the topics of “Special Enrollment Period” and “Should I Get Part B.” It states “You have 8 months to sign up without a penalty. This period will run whether or not you choose COBRA. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B.”
Rob, you did everything correctly by going to Social Security and taking them the “Request for Employment Information” form signed by your HR. You were within the correct time limits.
Group health insurance plans are a state specific regulated industry not a Medicare regulated plan. Since you are past 65 and most likely enrolled in Medicare Part A,(Inpatient Hospital) the COBRA health plan is passing the 80 percent of the doctor/medical bills to Medicare, but not Medicare Part B(Medical) which covers doctor care while in the hospital.
My advice would be to inform the COBRA health plan that you have filed your Social Security “Request for Employment Information” and which month your Medicare Part B will begin. You wish to appeal the COBRA’s decision because you did not have proper time to apply for Medicare Part B when no longer a full-time employer, but have applied during Medicare’s 8-month time limit to refrain from receiving a Medicare Part B penalty.
For questions regarding enrolling properly in Medicare, call the Toni Says® Medicare hotline at 832-519-8664.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question? Email Toni at email@example.com.