Employer coverage Medicare

What is Equitable Relief and How Can it Help My Situation if I Lost My Medicare Part B or Can’t Get it Reinstated?

What is Equitable Relief and How Can it Help My Situation if I Lost My Medicare Part B or Can’t Get it Reinstated?
Information for people struggling to get their Medicare Part B

Equitable relief is a process created for individuals who have unintentionally or by the mistake of someone else, lost their Medicare Part B.

Equitable relief was created under federal law to allow seniors, retirees, or people with disabilities who have Medicare to request relief from the Social Security Administration for immediate or retroactive enrollment into Medicare Part B without waiting for the General part B enrollment period which lasts from January-March each year.

Here are some common situations Medicare recipients, retirees, or people with disabilities can experience which can lead to people in losing their Medicare part B:

  • An agent or someone representing the Federal Government mis-advised them to either cancel their part b, and the information was provided by someone who may not be knowledgeable as to how important part B is when it comes individuals who need to see their medical providers.
  • When part B premiums were not paid on time and they missed the grace period, due to wrong information received from an insurance agent or a representative from Social Security.
  • Mis-communication when people new to Medicare B assume that the premium would be taken out of their Social Security Retirement check, when they haven’t applied for retirement benefits ( due to advise received from a Federal or insurance entity.

Some other common situation to be wary of:

  • If you were eligible for Medicare Part B, but didn’t apply because you had coverage through your spouse’s job, but your coverage under your spouse was terminated after your spouse was laid off, or lost their group coverage – but you didn’t apply for Medicare part B within the 8 month special election period from the date of your spouses group insurance coverage termination.
  • When a Medicare beneficiary has Medicare Part A, but still working, and the coverage they had through their Employer got terminated due to not making the required amount of hours.. and the beneficiary comes to realize that they were not informed that they needed to apply for Medicare Part B within the 8 month special election period.
  • You are eligible for Medicare and then lose your job or retire and pick up COBRA. You can miss your special election period to apply for Medicare Part B  which lasts for 8 months after your employment related coverage ends. While your Cobra plan can continue for up to 18 months,  applying for Medicare Part B after the 18 months can put you in a situation where you can be locked out of applying for Part B  until the general enrollment for part B which lasts from January- March, and becomes effective July 1st.  Because you missed the window to apply for your Medicare part B you’d be locked out of Part B until as late as the following July – and pay a premium penalty for the rest of your life.
  • If you don’t enroll in Medicare Part B when you’re first eligible and you don’t have other group health plan coverage, your monthly Part B premium may go up 10% for each 12-month period you could have enrolled in Medicare Part B, but didn’t sign up.

For SSA to grant equitable relief, SSA must determine that our failure to enroll in Medicare Part B was because it was due to:

  • Unintentional, inadvertent, or erroneous and was the result of a mistake, misrepresentation, error, or inaction of a person, federal employee, agent, or someone who is authorized by the federal government to act in its behalf.

For example if you wer told not to enroll in Medicare part B, not pay the premium or advised by a Social Security representative that you did not need to enroll, this may server as ground for equitable relief.

How can you file for Equitable Relief?

A detailed letter must be written explaining that you received wrong information from a federal employee – Someone from 1800 Medicare, Social Security Administration, health insurance agent,  or someone acting on the behalf f the federal government such as a Medicare health plan.

In the letter, you have to provide as much detail as possible.

Make sure you include all the dates and times you spoke with the representative which gave you wrong or misleading information. Describe the whole conversation and the outcome of the conversation. Make copies of all related documents to provide to the Social Security Administration. Keeping copies of your documents is important.

After submitting the letter, you have to follow up with the Social Security administration at least on a monthly basis, or a biweekly basis for any status and updates. You can take it a further step and contact your Congress person, or Senator and ask them to follow up with the Social Security Administration for you.

Keep in mind that equitable relief is not a formal legal process, but you should not be deterred from filing for equitable relief. Many people have been successful in their pursuit of relief.

To get a copy of a draft letter to know which format you can use, The Medicare Rights Center has set our a link for your convenience.

Follow this link here: https://www.medicarerights.org/PartB-Enrollment-Toolkit/Equitable-Relief.pdf

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