If you want to request Medicare equitable relief, you must fail to enroll in Medicare due to a federal employee’s error or inaction. Federal employees could be those working at Social Security or Medicare. But, you won’t qualify for equitable relief if your employer misinforms you about your Medicare rights and options.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
So, if you delay enrollment due to a Medicare representative saying you don’t need to sign up, even though you needed to sign up, you may have grounds for getting equitable relief. But, that’s only because a federal employee gave you misinformation. If your boss said you could delay enrollment and do your due diligence by contacting Medicare, you wouldn’t have grounds for equitable relief.
What is Medicare Equitable Relief?
Equitable relief is a process that allows you to request immediate or retroactive Medicare enrollment. Also, it can allow you to request the elimination of the Part B late enrollment penalty.
Who Can Obtain Equitable Relief?
Equitable relief is only for those who have or had Marketplace coverage and are entitled to premium-free Part A. Also, you must have an Initial Enrollment Period that began April 1, 2013, or later. Or, you must have been notified of a retroactive premium-free Part A award on October 1, 2013, or later. To qualify for the penalty reduction, you must have a Part B late enrollment penalty from 2015, 2016, or 2017 General Enrollment Period.
Generally, the penalty is waived, not reduced. Those requesting equitable relief must provide documentation showing enrollment in Marketplace coverage. You must be eligible for Medicare to enroll in Medicare. You can’t get equitable relief if you pay for Part A. Those in an Initial Enrollment Period won’t be eligible because they aren’t subject to a late enrollment penalty.
How Do I Request Medicare Equitable Relief?
To request equitable relief, you need to write a letter to the local Social Security office detailing the misinformation, causing your enrollment delay. You must be as specific as possible in the letter. You’ll need to include the name of the representative you spoke with, the date and time of the conversation, and any other relevant notes.
Also, provide information indicating if you want to keep your coverage going forward, retroactive coverage, or eliminate the Part B late enrollment penalty. Now, if you do request retroactive coverage, you must pay premiums back to the time coverage begins.
How to Follow Up With a Request for Medicare Equitable Relief?
Social Security doesn’t have to respond to equitable relief requests within any timeframe. Also, they aren’t obligated to send you a formal decision in response to your request.
You will follow up with your request through your local Social Security office about a month after submission. You can also contact a legislative representative, like a member of congress, and ask them about your case.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
If Someone Enrolls in Part B Through Equitable Relief, When Does Coverage Begin?
Medicare Part B will begin the month you enroll. To ensure there are no coverage gaps, we encourage you to enroll in Part B using equitable relief first and continue your Marketplace plan until you receive confirmation of Part B enrollment.
What Type of Documentation Does a Person Need to Provide for Equitable Relief?
To be eligible for equitable relief, you must show documentation reflecting enrollment in a Marketplace plan for individuals or families. Acceptable documentation includes periodic data match notice, Marketplace eligibility determination notice, IRS Form 1095-A, receipt of premium binder payments, and other documentation that reflects enrollment in a Marketplace plan.
FAQs
How to Find a Medigap Plan After Equitable Relief Approval
Once you have Part B and your equitable relief submission is complete, you'll want to consider a Medigap plan. Medigap insurance covers the gaps in Medicare. So, instead of you paying deductibles and coinsurances, the insurance company can pick up those costs.
Our agents can walk you through all the details of Medicare and guide you to the best policy. Give us a call at the number above to see your rates today. Or, fill out an online rate form and get your rates now.
Enter ZIP Code
Enter your ZIP code to pull plan options available in your area.
Compare Plans
Select which Medicare plans you would like to compare in your area.
Get Quote
Compare rates side by side with plans & carriers available in your area.
If my 90 year old grandmother has Part A but not B, will she be penalized if she needs pet B now?
Hi Annie, the Part B penalty will be assessed if she has not had creditable health coverage in place since turning 65. If she does have health coverage, you will want to speak with your local Social Security office to ensure the coverage is creditable. If so, no penalty!
Am 69, retired when 62 / disabled, had part A/B/D; then dropped B and D couple years ago, needed the extra money. Today called SS to get part B and D. They said have to pay penalitys. I was not told by SS workers about Penalities when dropped B and D.
Omission, failure to provide me with said information is error, misrepresentation by SS representive is violation of federal law. How do I get SS to eliminate penalities? 17 CFR 240.10b-5 misreprsentation
Hi Duane. You’ll have to submit a redetermination request to Medicare. You will need proof of the conversation you had with the Social Security worker to submit with the form.
Duane, depending on your total household family income you may be able to get most if not all of your penalties waived (or paid for by the State in which you live) through two separate programs. One is called extra help or LIS which stands for low income subsidy. The second is a program called MSP or, Medicare Savings Program.