Question: I am 66 and just preparing to sign up for Social Security. I did NOT sign up for Medicare because I had insurance from the exchange (Marketplace). Now they tell me I cannot sign up for Medicare and I will have a penalty. What do I do? I had insurance, what did I do wrong?

Answer: I am sorry for your confusion. The Medicare and Social Security (Retirement Benefits) rules often get confused. For many years both Medicare and Social Security began at age 65. That was easy to keep track of, they were both 65 years of age. A number of years ago they pushed the Social Security Full Retirement Age back to 66 (for those born prior to 1954) or back to 67 for those even younger. Medicare has remained at age 65.

What does that mean? Well you are one of the people this article could help.

Individuals who had insurance from “The Marketplace”, (“The Exchange”, “Obamacare”, or one of the many other names it has), may have decided to not sign up for Medicare or did not realize they needed to. The insurance you have is relatively low cost (maybe even free) and you did not sign up for Medicare. That may be because you liked the plan you had, the premium was low, or you just did not understand the system.

Now you have just found out that you missed your Initial Enrollment Period (turning 65). That means you cannot sign up now, and when you do sign up you will have a penalty because of your earlier choice. That is really frustrating and a little bit scary.

Well let me say you are not the only person to have done this. This has become a relatively common mistake. For that reason, Centers for Medicare and Medicaid Services (CMS) has created a way to correct that mistake. They have designed an Equitable Relief Opportunity (Special Enrollment Period-SEP) to sign up for Medicare that also includes relief from the Part B late enrollment penalties.

This is a very important Equitable Relief. It means that individuals like you, have an opportunity now to sign up for Medicare Part B. That deadline is fast approaching. On Sept. 30, the Special Enrollment Period that allows you to correct your mistake ends. That means as of Oct. 1, you can no longer use this opportunity. It is my hope that this will be extended as it has been extended once already, but do not count on that. Take the time now to get this situation resolved.

This Equitable Relief is also for those individuals who are already paying a penalty due to late enrollment in Medicare. This Equitable Relief can eliminate the premium penalty they are paying due to keeping a Marketplace plan instead of signing up for Medicare when they first became eligible or turned 65.

My recommendation it to look into this Equitable Relief and see if this could help you. You need to complete Form CMS-40B and then turn it in to Social Security Administration (SSA). You must also prove that you had insurance through the Marketplace using a variety of documents, such as IRS Form 1095-A or Premium notices, or eligibility determination notices from the Marketplace Plan.

There are also agencies that can help you with this issue, local agencies, like Southwestern Independent Living Center or Center for Elder Law & Justice. There are national agencies like, Justice in Aging or The Medicare Rights Center. These agencies work with individuals on a whole host of difficulties and issues related to Medicare. This Equitable Relief eligibility dates back all the way to April of 2013 when the Marketplace Plan were first offered. So it isn’t just recent Medicare enrollees who can be helped with this Equitable Relief opportunity to begin Medicare Part B, or have the premium penalties reduced. For those individuals that did not enroll in Medicare Part B prior to March 1, 2013, this Equitable Relief cannot help their situation.

If you use this Equitable Relief program prior to the September 30, 2018 deadline, your Medicare Part B will begin the first of the following month you file the paperwork. You can also ask that your Medicare Part B begin up to two months retroactively.

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Remember that if you ask for the Medicare Part B to be retroactively started, you will be responsible for those Medicare Part B premiums for those two months. You should not cancel your Marketplace Plan until you are notified that your Medicare Part B enrollment has been completed. You do not want to have a gap in your coverage.

This Equitable Relief system incorporates an SEP that individuals can use to enroll in a Part D plan, a Medicare Supplement Plan or a Medicare Advantage Plan of their choice. So signing up for Medicare Part B is an important part of the process, but not the only part of the process. The Equitable Relief program allows you to enroll into Medicare Part B and then you must make additional insurance enrollment choices. Those additional enrollments must be done within two months of your Medicare Part B start date.

The Marketplace Plans can be Creditable Coverage for Part D, so many individuals will not see the penalty of no drug coverage.

This question and problem is especially complicated. A website that may have useful information is https://marketplace.cms.gov/applications-and-forms/notices.html. The www.SSA.gov, and www.medicare.gov websites also have helpful information.

All of this information boils down to the fact that you have a Marketplace Plan and just found out that you can’t sign up for Medicare Part B. You NOW know that you can use this Equitable Relief process to fix your situation. All this information also means that for those individuals who are paying a premium penalty for enrolling in Medicare Part B late because they had a Marketplace Plan could get their Medicare Part B premium reduced. That is good news!

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at janells@lutheran-jamestown.org.