HELP LINE: What to do if you miss open enrollment

THIS IS ONE of those columns, meaning it won’t touch all of us, so it’ll be easy to think “click” and move on.

However, if you’re one of the folks it does touch — or if you know someone it might touch — then please care deeply because not caring could bring extremely unpleasant consequences down the way.

Here’s the deal: Many, many, many of us are becoming Medicare-eligible (meaning, for the most part, turning 65) on a daily basis.

That might or might not be “good news,” depending upon your circumstances and how you look at life, but it’s the truth nonetheless.

Prior to becoming Medicare-eligible, quite a few of us had no realistic choice for obtaining health insurance other than to go through the marketplace.

“Marketplace” is another term for Obama­care, or you might have heard “exchanges” or whatever — it’s all the same — but the fact is that you went through a marketplace, found a health insurance policy you could afford and, in all probability, got a subsidy (“tax credit,” “Advance Premium Tax Credit,” whatever — it’s all the same). Yay, life went on.

Then you became Medicare-eligible, did your homework and said to yourself, “Well, piffle. It’s cheaper for me to stand pat with my current policy-plus-subsidy than to pay those Medicare Part B premiums, so never mind.”

Thinking was wrong

Your math was right; it was your thinking that was wrong.

What you didn’t realize was that for almost all of us, “Medicare-eligible” means Medicare Part A-eligible (which is free, for most of us).

When you became Part A-eligible, you simultaneously became ineligible for those happy little subsidies.

By the time you figured that out, you were past your initial Medicare enrollment period, which meant that you had to wait for a general enrollment period, which probably meant that you would incur a Part B late-enrollment penalty for the remainder of your natural, health-insured life.

Ouch. Now what?

Well, between now and March 31, you can apply for “equitable relief,” which will grant you a “Special Enrollment Period” to enroll in Part B, and that dreaded Part B late-enrollment penalty will not apply.

If you’re in this situation, you want to do this.

Now, the Center for Medicare & Medicaid Services has mailed notices to folks they know of that are 65 or better and, in this situation, advising them to drop marketplace coverage and enroll in Part B, but said notices do not mention this “equitable relief.”

Contact SSA

So, if you got one of these notices (or even if you didn’t, but you know darned good and well that you’re in this situation), you want to contact the Social Security Administration right now and apply for this “equitable relief.”

If you have any information or documentation on how you learned that the subsidies would not apply (or why you thought they would), submit it. Maybe the notice mentioned above from CMS? Notes from conversations? Or emails, or … whatever.

Submit it. It doesn’t have to be “formal” or from the feds.

If you’ve got questions (and you probably do), go straight to the pros: Medicare Rights Center at 800-333-4114.

If this sounds like you to you, don’t mess around with this. Do it now. The rest of your health-insured life will thank you.

I realize, too, that this brings up something that is being brought up incessantly. And that is that with a shiny, new federal administration on its way in, what’s going to happen to Obamacare and those subsidies?

Or, for that matter, what’s going to happen to Medicare? Or Medicaid?

Here’s the truth: Nobody knows.

Here’s what I do know: Talking about doing something is not the same as “doing something.”

Also, if somebody actually gets around to doing something, it won’t happen overnight. So if it were me (and it is), here’s what I’d do: Nothing.

Seriously, just keep on doing whatever health insurance-related thing you’re doing, by the “rules” as they exist today, and see what happens.

The worst thing we could do is attempt to read tea leaves, do something stupid, then discover that we’ve just done something stupid.

Just carry on.

And if anyone (or any entity or company or mythical “agency,” or whomever) contacts you to say that they know what’s going to happen and they can “fix” it for you (for a fee), hang up, delete it or shred it, because you’re being scammed.

I promise that you’ll know what I know as soon as I know it.

For now, there’s nothing to know, so just go straight ahead and don’t let fear ruin the new year because here’s something that has not changed: Every single day is a new opportunity — a gift.

Accept it graciously.


Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing [email protected].

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