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Request for Medicare Equitable Relief Process


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.

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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.

If Someone Enrolls in Part B Through Equitable Relief, When Does Coverage Begin?

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

Where do I submit Medicare equitable relief cases?
You will submit an equitable relief case to your local Social Security Office.
What if I'm denied equitable relief?
There is no formal appeal process if you’re denied equitable relief.  Instead, you’ll submit your request with more or different information as many times as necessary to get approval.
Is equitable relief available to beneficiaries that had or have State-Based Marketplace insurance?
Yes, equitable relief is available to those enrolled in both Part A and a Marketplace plan. It doesn’t matter if the Marketplace insurance is Federally-facilitated or a State-Based plan.
Why can't people with an Initial Enrollment Period on or before March 1, 2013, get equitable relief?
These people won’t qualify for equitable relief because Marketplace wasn’t available during their Medicare Initial Enrollment Period nor a factor in their decision to refuse Part B.
Is equitable relief available to those with premium-free Part A due to age or disability?
Yes, the basis for a person obtaining Medicare is not a criterion for assistance.

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.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

3 thoughts on “Request for Medicare Equitable Relief Process

  1. 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

    1. 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.

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