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Stephanie O Joy, Esq
Stephanie O Joy, Esq, Soc. Sec. Attorney
Category: Social Security
Satisfied Customers: 13281
Experience:  19+ years legal exp. - 10+ years owning/operating her own SSD Law practice.
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I have a Medicare Part /Health Insurance Problem: I enrolled

Customer Question

I have a Medicare Part B/Health Insurance Problem:
I enrolled in Medicare Parts A and B in May of 2015.
I have been very behind in my mail and bills. Today, 9/30/2015, I finally got to my mail and discovered I had received a medicare payment delinquent notice for my Part B coverage. It said that my payment was delinquent and my termination date was TODAY - 9/30/2015. I called Medicare and they said I could go online and make a payment through my bank. They had no other remedy. But the bank payment will not post for another day - meanwhile I posted the bill payment to Medicare from my bank, which they will get on 10/2. I called my Medicare Advantage Provider and they said I was terminated from part B (Part A is still OK) as of 10/1/2015. There was only a machine - said to call back in the morning...
If I am terminated, the delinquent notice says I cannot re-enroll for Medicare until January 2016 and the coverage will not start until July of 2016! So meanwhile I have no Part B coverage and no Medicare Advantage for Part B (or D, covered by my Medicare Advantage Provider).
Questions: Is there any way I can fix this at this late time/date and keep myself (or restore myself) to my Medicare Part B now?
If I have no recourse with Medicare what are my best options in NYS? I have no medical coverage from my employer.
Submitted: 1 year ago.
Category: Social Security
Expert:  Stephanie O Joy, Esq replied 1 year ago.

I know of no way to circumvent the very strict rule on these ridiculous enrollment periods. So what I would do is go to the healthcare marketplace (exchange/Obamacare) and find the best coverage you can afford that fits your needs, so you can have coverage though 7/2016. Depending on your income, these policies are well-subsidized, so while it likely won't provide the same coverage at 104.90, it may be pretty near that - again, sliding scale, depending on your income. You may wish to start here:

https://nystateofhealth.ny.gov/

Expert:  Stephanie O Joy, Esq replied 1 year ago.

I hope this helps! My goal is to provide you with excellent and accurate service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Kindly rate me "excellent" when you are done. I look forward to assisting you in the future, should you have legal questions. Be sure to start future posts with "To Stephanie O Joy Esq., ONLY" if you want me to specifically answer it.

Sincerely, ***** ***** Joy, Esq.

Your online SS legal resource{C}

Customer: replied 1 year ago.
Hi - Ugghh...When I contacted Medicare they told I should contact Social Security, as they are the ones who in charge of reinstating etc. I sent SS a message - no response yet. They sent me an email saying they are looking at my question, if I want to, I should contact my local SS offfice.I'm guessing this is nothing but more government BS, and I will probably end up wasting time - they will say there is nothing to be done. Is it possible that they will reinstate if I tell them I have a medical condition that I need coverage for and my payment is also pending, or will it remain like you said and be another dead end?Medicare was a complete waste of time - they barely understood my problem and after half an hour and ratttled off exactly what it says on the payment form and good-bye....Tnx
MNG
Expert:  Stephanie O Joy, Esq replied 1 year ago.

It is so frustrating, I know. I have not heard of an instance where failure to enroll during enrollment was waived due to the fact that coverage was needed for a medical condition in the Medicare Scenario. I suspect that is because nearly everyone has a medical condition for which they need the coverage. That said, bugging them costs you nothing, so while you research a suitable policy you can handle stil. 7/2016, I'd go at that angle as well. Flukes happen. And, ObamaCare open enrollment may be starting Nov. 15 (not my specialty, but just happened to hear of it). Since you NEED to have coverage, I think you really need to consider looking at these other options. When we ourselves decided to look to change insurance, by looking into the "marketplace"/exchange, we did so by meeting with an insurance agent (in our case, it was BCBS) and he actually showed us policies from many companies, explained the bronze, silver, etc. plans and did not himself sell us anything. We signed up ONLINE, and that is what he sought to explain.

Now, that said (that I think you should utilize all avenues), going back to the issue of reinstatement, look at this:

http://www.gpo.gov/fdsys/granule/CFR-2011-title42-vol2/CFR-2011-title42-vol2-sec408-100

Scroll down to 408.100 etc.

Review your dates and see if you can appeal and get reinstated based on this section.

Expert:  Stephanie O Joy, Esq replied 1 year ago.

I hope this helps! My goal is toprovide you with excellent and accurateservice – if you feel you have gotten anything less, please reply back, Iam happy to address follow-up questions.

Kindly rate me "excellent"when you are done. I look forward to assisting you in the future, shouldyou have legal questions. Be sure tostart future posts with "To ***** Esq., ONLY" ifyou want me to specifically answer it.

Sincerely, ***** ***** Joy, Esq.

Your online SS legal resource!

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