Medicare Giving Reprieve to People Confused by ACA

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CMS is giving seniors until September 30, 2017, to request a waiver from all or part of the penalties they face for not enrolling on time for Medicare.

The Affordable Care Act (ACA) requires people to have insurance—and many who signed up for coverage on the exchange thought once they did, they were in the clear.

That meant they didn’t understand that they still had to follow existing federal laws that require people turning 65 to enroll in Medicare. And many didn’t.

Now, CMS is giving this group a chance to fix their mistake and avoid the penalties that came with it. They have until September 30, 2017, to request a waiver of the penalties Medicare assesses when people delay signing up for Medicare’s Part B, which pays for visits to the doctor and outpatient care (Medicare Part A covers hospitalization and skilled nursing care). Others who are paying penalties can try to get rid of all or part of them.


Why did people stay in the marketplace? Initially, the coverage through the Marketplace with financial assistance may have been more affordable than Medicare Part B, and they thought they could keep collecting the cost-sharing reductions that were part of this coverage. But that caught up with enrollees in 2016 who were sent notices that once enrolled in Medicare Part A they cannot receive tax credits and cost-sharing reductions.

These enrollees found out the hard way that not only were they not eligible, but now they would be assessed a Medicare Part B late enrollment penalty, according to a notice posted on CMS’ website.

According the CMS website, this relief is only available to those who enrolled in both Medicare Part A and a Marketplace plan and who did so after March 1, 2013. People who skipped Medicare enrollment for other reasons or did it long ago are not entitled to relief.

It won’t be automatic: seniors will have to provide documentation, premium notices, and proof of payment. Once they enroll in Medicare Part B, coverage should start the month the person enrolls, according to CMS.

Seniors making the switch will also get a special enrollment period to enroll in Medicare Part C and Part D. CMS states on its website: “As individuals will be assessed a Part D late enrollment penalty if they go without Part D or other creditable coverage for 63 days or more, we encourage individuals to enroll in a Part D plan (either a stand-alone Part D plan or a Medicare health plan with Part D coverage) as soon as they drop their coverage through the Marketplace.”