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 this March, I was rushed to the ER because of kidney failure, which was caused from stage 4 of prostate cancer that has now spread to my pelvic bones.

                        Because I was working full-time, I took a leave of absence and short term disability in March for 60 days while receiving my cancer treatment.  Short term disability ended on June 24th and so 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, would no longer be part of the company’s health plan and that 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 August 1st.

            Now my Cobra nightmare begins… because COBRA is only paying the 20% of medical/doctor bills and I was billed the 80% because I was not enrolled in Medicare Part B which has totaled over $40K.

            Please help me with what I need to do…Thanks, Robert NW Houston area

Robert:

            The Toni Says team will do all that we can to help you solve this problem of your` $40K Medicare Part B medical bills.

            Those reading this article need to realize the seriousness of Medicare and insurance rules.

            On page 26-27 of the 2016 Medicare & You handbook it discusses the topics of “Special Enrollment Period” and “Should I Get Part B”.  It states on page 27 under # 1.  “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.”

            Robert, 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.

            You are in an insurance “glitch” and they are using “Coordination of Benefits” as their ruling.

            Group health insurance plans are a state specific regulated industry not a Medicare regulated plan.  Since you are past 65, the health plan is passing the 80% of the doctor/medical bills to Medicare.

            I am seeing a change in group health plans with many not covering employees past their last day of work.  Unfortunately, you are in the middle of a healthcare crisis, when technically you went from full-time employee to a part-time employee because I know you and your company want you to return back to work as a full time employee.

            I am a Medicare advocate and consultant, but if there are HCN readers of this column who are attorneys or have experienced with this type of issue, please email me personally at toni@tonisays.com and I will give your information to Robert who needs all of our help and prayers to get through this trying personal time when he should be playing with his grandkids.

            Confused about Medicare Workshop are beginning Tuesday September 13th in Friendswood.  Check the Toni Says website at www.tonisays.com for a Medicare/Social Security workshop in your area. Please RSVP 832/519-8664.           

            Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com  Email questions to info@tonisays.com or call 832/519-TONI (8664).

 

 

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