Q: Someone gave me bad advice and I delayed enrolling in Medicare Part B. Now I’m told I’ll owe a late penalty, and have to wait months for my Part B coverage to take effect. Can I get the penalty erased and have my Part B take effect sooner?
A: It depends on who told you to delay Part B. You may qualify to have your penalty waived if you were advised by an employee or agent of the federal government – for example by Social Security or 1-800-MEDICARE – to delay Part B. Asking for the correction is known as requesting equitable relief.
What is the late enrollment penalty for Medicare Part B?
Medicare Part B enrollment is complicated, and the wrong decision can leave you without health coverage for months – and lead to lifetime premium penalties. Part B premiums increase 10% for every 12 months you were eligible for Part B but not enrolled. People who delay Part B because they were covered through their own or a spouse’s current job are exempt from this penalty, and can generally enroll in Part B without any delays.
However, people who delay Part B enrollment without having current job-based health coverage can find themselves out of luck. They don’t qualify for the Part B Special Enrollment Period and can’t enroll in Part B until the next General Enrollment Period (GEP), which runs from January to March of each year, with coverage effective the month following enrollment (coverage used to take effect in July, but that changed as of 2023). The GEP for the current year may have passed by the time you discover you need Part B, potentially delaying your Part B coverage effective date by an entire year. (More information about the Part B Special Enrollment Period is here.)
Can I get a Part B penalty waived?
People make Medicare enrollment errors for a variety of reasons, and equitable relief is not available for all of them.
If you find yourself without Part B coverage or are paying a penalty because you received bad advice from the federal government, Social Security may be able to waive your Part B penalty, enroll you into Part B, or do both things. This can be a big help if you would have otherwise had to wait to enroll during the GEP.
Unfortunately, you can’t get equitable relief if you were misadvised by your employer. In my experience, human resources departments often give out bad advice about Part B. So it’s a good idea to contact Medicare or the Social Security Administration to confirm any information you’ve been provided by your employer about whether you need to enroll in Part B.
You can ask to be enrolled in Part B with a retroactive effective date if bad advice caused you to have a gap in coverage. If you do this, you’ll need to pay Part B premiums for the entire time you want to be enrolled. Alternatively, you can ask to have the Part B penalty waived and just be enrolled going forward. Be sure to clearly specify what it is you want Social Security to do when you make your request. They may or may not agree to your request, depending on the results of their inquiry into your situation. But you should make sure they know what solution you’d like.
How do I appeal a Medicare Part B penalty?
You’ll want to document as much information as possible about when someone from the government told you not to take Part B. This can include the date and time of your conversation or phone call, the name of the person you spoke with, and what you did as a result of the information you were given. Here’s a sample letter to guide you.
Once you’ve put everything together, you can submit your equitable relief request to your local Social Security office. (Contact Social Security at 1-800-772-1213 or check www.ssa.gov to find the mailing address for your local office.) There is no time limit for Social Security to respond to your request for equitable relief, so be prepared to follow up at periodic intervals. And understand that there is no appeals process or formal procedure to follow if your request is not granted. But it’s in your best interest to try anyway. It can also be helpful to involve an elected representative who can advocate on your behalf. You’ll also want to keep a copy of your request for your records.
(You may be eligible for equitable relief if you delayed or declined Medicare Part B because you had coverage through a Qualified Health Plan purchased from the health insurance Marketplace between 2014 and June 2020. The rules for this type of relief are stricter and are time-limited. More information about that is available here.)
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh worked on federal and state health insurance exchanges at the technology firm hCentive.
Footnotes
Tags: delayed enrollment, equitable relief, Medicare Part B, penalties
