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.
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.
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