Medicare to Provide Relief for Late Medicare Part B Enrollment Penalties in Certain Circumstances

Many Americans who enroll in Medicare Part A mistakenly think that because they have a Marketplace Insurance plan, they do not need to enroll in Medicare Part B. Unfortunately, enrolling in Medicare Part B late can result in late-enrollment penalties. These penalties can affect a person’s Medicare premium for his or her entire lifetime.

Medicare Part B covers medical services such as doctor’s visits, surgeries, durable medical equipment, laboratory tests, and inpatient and outpatient hospitalization.

The good news is that there is currently a waiver program being offered in certain circumstances for those who did not enroll in Medicare Part B. The Centers for Medicare & Medicaid Services (CMS) is offering equitable relief for Medicare beneficiaries who are currently enrolled in Medicare Part A and have coverage through an individual Marketplace plan, also known as a Qualified Health Plan. This relief is available for an individual who had an initial enrollment period that began April 1, 2013, or later, or was notified of retroactive premium-free Part A on October 1, 2013, or later.

Those individuals who were enrolled in a Marketplace plan who want to enroll in Medicare Part B can request a late enrollment penalty reduction. However, this relief is only available through September 30, 2017. To be eligible for the relief, a request must be made by the September deadline.

Additionally, for individuals who qualify for relief, CMS will allow coverage to begin the month that the individual enrolls in Medicare Part B, instead of imposing the typical waiting period for coverage. However, to prevent any possible gaps in coverage, if a person currently has a Marketplace plan CMS recommends keeping that Marketplace plan in place until verification of enrollment in Part B is received.

Individuals who were enrolled in Medicare Part A and a federally-facilitated Marketplace plan should have received a notice explaining the relief. If an individual terminated his or her Marketplace plan and already enrolled in Medicare Part B with a late-enrollment penalty, a notice will not be sent, but the relief is still available.

If you received a notice or believe you may qualify for relief, CMS directs that you contact the Social Security Administration by telephone or visit your local Social Security office and mention equitable relief. Documentation of Marketplace enrollment must be provided to Social Security when seeking such relief.

For more information please visit  CMS Medicare Enrollment Equitable Relief Fact Sheet and Medicare Rights Center Equitable Relief Information.

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