Medicare Recipients Fall Into the Gap

Question: I have fallen into a Medicare crack that I’m sure must have swallowed up tens of thousands of other people as well. Several months before I retired at the end of February, I attended a meeting sponsored by my employer at which representatives from the local Social Security office were in attendance. There were about 20 of us, and some had already reached 65, others were within a few months of it.

The Social Security people were helpful and--because we had all brought the necessary documentation--they signed all of us up for both Social Security and Medicare, both for Part A (the basic Medicare, covering hospital and skilled nursing care primarily) and Part B (covering items like doctors’ hospital care, doctors’ office calls)--or so we assumed.

A few weeks after retirement, I visited my doctor, routinely paid the bill and then sent it to Medicare for my 80% reimbursement.

Imagine my shock a week or so later when Medicare rejected the bill because I was “not covered” under Part B. In April I went to my local SS office and was told by a representative that I couldn’t have been signed up for B at the meeting I attended, because I was still working at the time, and that you can’t sign up for it until you stop working.

She volunteered to sign me up on the spot, but said I still wouldn’t be eligible for Part B benefits until July 1 because I hadn’t signed up immediately after retiring.

I wonder how many thousands of people going on SS are finding that they are “naked” as far as doctors’ bills are concerned for three, four or five critical months? And I still haven’t been able to get a satisfactory answer from anyone as to how this can be justified!--G.C.

Answer: Social Security doesn’t think the misunderstanding is as widespread as you paint it, but because I’ve encountered much of the same sort of inter-departmental confusion myself, I can’t really think that you’re overstating it all that much.

Until August, 1986, the enrollment procedure for Parts A and B was fairly simple: You signed up for Social Security and Medicare A and B in one fell swoop--either three months before the month you reached 65, the month in which you hit the 65 mark or in the three months after your birth month.

So there was a seven-month period to get the whole ball of wax out of the way.

But, a Medicare representative tells me, there was a certain amount of unfairness involved here for those who turned 65 but were still on a company payroll where the employer’s health plan covers the worker.

It didn’t matter in the case of Part A because there’s no charge for it. But the critical Part B carries a separate charge of $24.80 a month. And these people, still on someone’s payroll, would be billed for this even though they were not yet drawing Social Security benefits, and even though it would be duplicating medical coverage they were getting from their employer.

And it could go on for months or even years for employees who continued to work past 65. And so the procedure was changed in the summer of ’86.

What happens now, is that you can still enroll for Social Security benefits and Part A of Medicare in that same seven-month period but that you flatly can’t sign up for Part B until you have physically stopped working and your work-related medical coverage has stopped.

All well and good, perhaps, but what if your sign-up period doesn’t happen to fall in that seven-month enrollment period? Aren’t you then without coverage for doctors’ bills for three, four or five months?

“No, not at all!” the Social Security spokesperson says. You can go to your local Social Security office any time in the first month of retirement, sign up and take along a letter from your employer explaining that you were covered by your employer until such-and-such a date.

For those who don’t have an employer’s plan, the old seven-month sign-up still applies.

Assuming that you are able to go back and get such a letter from your employer, does it cover you retroactively to March 1 for those doctor bills you thought were covered?

Here, again, there were conflicting responses, but the consensus among Medicare practitioners is that, happily, such doctors’ bills will be honored as long as you have a letter from the employer spelling out when that coverage stopped. But the trauma you experienced when you thought you were uncovered certainly could have been avoided.