Is Medicare Part B Retroactive

How To Handle Retroactive Medicare Entitlement

by Medical Billing

Retroactive Medicare Entitlement

The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the filing deadline is caused by all of the following conditions:

At the time the service was furnished the beneficiary was not entitled to Medicare.

The beneficiary subsequently received notification of Medicare entitlement effective retroactively to or before the date of the furnished service.

Thus, a provider or supplier may have furnished services to an individual who was not entitled to Medicare. More than a year later, the individual receives notification from SSA that he or she is entitled to Medicare benefits retroactive to or before the date he or she received services from the provider or supplier. In this situation, the provider or supplier may submit a request for a filing extension to the appropriate Medicare claims processing contractor, as long as the provider or supplier submits supporting documentation that verifies that the conditions above are met.

Where retroactive Medicare entitlement is alleged, the provider, supplier, or beneficiary will need to provide the contractor with the following information:

an official Social Security Administration letter notifying the beneficiary of Medicare entitlement and the effective date of the entitlement and,

documentation describing the service/s furnished to the beneficiary and the date of the furnished service/s.

Medicare Part B Premium Reimbursement For 2022

SPECIAL NOTICE: This article only applies to Retired Members and Qualified Surviving Spouses/Domestic Partners of the Los Angeles Fire & Police Pension Plan.

The Centers for Medicare and Medicaid Services has increased the standard Medicare Part B monthly premium to $170.10 effective January 1, 2022 however, you may pay a different amount determined by CMS.

• If you are a new Medicare Part B enrollee in 2022, you will be reimbursed the standard monthly premium of $170.10 and will only need to provide a copy of your Medicare card.
• If you received a Medicare Part B reimbursement of $148.50 or less on your pension check in 2021, you will need to provide documentation to update your Part B reimbursement amount for 2022.
• If you have been receiving a Part B reimbursement that is lower than your basic Part B premium, you may be retroactively reimbursed for your Part B premiums for up to 12 months.

Can Medicare Part B Be Retroactive

Part B coverage retroactivelyPart B

If you’re looking to reenroll in Medicare Part B, follow these steps:

MedicareMedicareyouPart B automaticallyMedicareyouyougettingMedicareyouyouPart BavoidpenaltyPart Bpenalty

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Medicare And Sers Health Care Coverage

If you are enrolled in a non-Medicare plan through SERS, you will receive an Approaching 65 packet three months prior to your 65th birthday.

This packet will contain information on enrolling in Medicare, as well as SERS Medicare plan information. Once you enroll in Medicare, SERS will transfer you from your non-Medicare plan into a SERS Medicare Advantage Plan. With SERS coverage, your premium with SERS will be reduced. You also will be eligible to receive $45.50 per month from SERS to help you pay your Medicare Part B premium.

Eligibility for SERS health care coverage will end if you do not enroll in Medicare Part B during your Medicare Initial Enrollment Period at age 65 or your Special Enrollment Period following the loss of employer coverage. Failure to maintain Medicare Part B enrollment will also result in the loss of eligibility.

If you previously waived SERS coverage, you have 90 days within becoming eligible for Medicare to enroll in a SERS Medicare Advantage plan. Call Health Care Services toll-free at 800-878-5853 for a health care application and current premiums.

If you waive SERS coverage when you become Medicare eligible, it is highly unlikely that you will be able to re-enroll in the future.

Your First Chance To Sign Up

Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.

Avoid the penaltyIf you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called Premium-Part A.

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What If I Dont Sign Up For Medicare Part B Because I Have Other Health Insurance

There are situations where you can keep your current health insurance. You can keep your plan if you have creditable coverage through your employer, spouses employer, or a union. You will not have to pay the penalty for delaying Medicare Part B coverage.

However, if your coverage is not creditable or you lose coverage , the clock begins to tick.

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Usually, you will be able to sign up for Medicare Part B right away, during a Special Enrollment Period. This is an eight-month window beginning when your employer coverage ends. If you do not enroll during this period, you will have to pay the Medicare Part B penalty. You will pay a 10% premium increase for each full 12 months you wait beyond the date the Special Enrollment Period began.

If you retire before age 65 and choose to extend your coverage using COBRA, you must end COBRA coverage once you are eligible for Medicare. COBRA is not creditable coverage to avoid the Medicare Part B penalty.

Refusing Medicare Coverage Can Be Costly For Those On Disability Insurance Who Dont Know The Rules

Q. I was granted Social Security disability in November 2008 and in February 2009 I received a letter saying I would receive Medicare Part A retroactively to 2006 and could have Part B as well. As I was already covered by my husbands Tricare military health benefits, I declined Part B. But now Tricare says I must repay the money it spent on my extensive medical bills in 2006-08. Is this true? If so, we face bankruptcy.

A. Unfortunately, it is true. And anyone who qualifies for Social Security disability insurance benefits especially in situations where Medicare coverage is granted retroactivelyneeds to be aware of the consequences of declining Part B enrollment if he or she already has any kind of employer health insurance.

If you qualify for Social Security disability soon after you first apply

In this situation, you do not get Medicare coverage immediately. Under current law, you must wait for 24 months after being approved for SSDI before Medicare health benefits under Part A and Part B can begin.

Once the 24 months have elapsed, you receive Part A automatically and get the option of enrolling in Part B. At this stage, if you already have health insurance from your own or your spouses employer, it is very important to contact the employers benefits administrators to find out what their policy is.

If you are granted Social Security disability retroactively

Your email address is now confirmed.

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What Would Happen If I’m Awarded Medicare Retroactively

I have been applying for SSDI. However, due to late filing and appeals, I do not expect to get a detrmination from SSA untill at least 3 years from my initial filing date. Because of it I expect my MEDICARE benefits to be awarded to me retroactively. Between the retroactive award date for MEdicare and the actual award date –I am planning to be covered by Obama care . What are the consequance of that? Would I be able to start Medicare without any penalties on the date of the actual award date . If there are penalties from Medicare — what kind If I am forced to start Medicare on the retroactive date — would I be forced to pay increased for ACA for the dates between retractive and actual date of Medicare. Would Medicare pay for my medical bills retroactively and then ACA would ask to pay the difference ? Are there any good options I have? Thank you very much for your help and the excellent service you provide to the community.

I’m not an expert on the Affordable Care Act, so I’m unable to answer your question about ACA premiums.

Best, Jerry

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Disclaimer:

Do I Qualify For The Medicare Part B Special Enrollment Period

You qualify for the Part B SEP if:

• you are eligible for Medicare because of your age or because you collect disability benefits.
• you had Medicare Part B or current employment-based health coverage in the month you qualified for Medicare and
• less than eight months have elapsed since you didnt have either current job-based group health coverage or Medicare Part B.

Some people may need to use the Part B SEP if theyre still working. Youll want to sign up for Part B if your employer has less than 20 employees. This is because your employer plan pays only after Medicare does. If you dont enroll in Part B, your employer plan will pay less for your care or nothing at all when it finds out youre Medicare-eligible. If your employer has more than 20 employees, you dont have to take Part B as long as youre still working, but a small number of people do enroll to lower their out-of-pocket costs.

You have to take Part B once your or your spouses employment ends. Medicare becomes your primary insurer once you stop working, even if youre still covered by the employer-based plan or COBRA. If you dont enroll in Part B, your insurer will claw back the amount it paid for your care when it finds out. At that point, you would need to enroll in Part B, but might no longer qualify for the SEP if you delayed enrolling for more than 8 months.

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Medicare Part A Retroactive Coverage And Hsas

Medicare Part A is a government administered health insurance plan generally for people aged 65 and older. It is a form of hospital insurance that covers inpatient hospital care, skilled nursing facilities, and other types of health care services. The general assumption is that Health Savings Account holders can maintain their HSA until they begin Medicare, and then easily hop onto Medicare Part A. As you will see, this may not be so, as there are some catches with Medicare Part A that affect your HSA eligibility based on your age and enrollment date.

People over the age of 65 do not have to sign up for Medicare they can remain on a personal insurance plan as long as they want. However, once you elect to being coverage, or begin receiving Social Security, you are enrolled in Medicare Part A. While this not only ends your HSA eligibility , it may affect your HSA eligibility in previous months. For those who begin Part A coverage after they have turned 65, there is a clause that retroactively applies Medicare coverage. It states that your coverage start date actually begins up to 6 months prior to your actual enrollment date. From the Medicare.gov website:

If you sign up within 6 months of your 65th birthday, your coverage will start at one of these times:

1) The first day of the month you turn 65

2) The month before you turn 65 .

After turning 65, youre coverage will be in effect the lessor of 1) 6 months or 2) your 65th birthday.

How Much Does Part B Cost

The Social Security Act sets out the Medicare premiums, deductibles, and copays each year.

An individualâs income determines what they will pay for their Medicare Part B monthly premium. For individuals with an income below $88,000, the standard premium is $148.50 in 2021, with an annual deductible of $203.

According to the Centers for Medicare and Medicaid Services, about 7% of Medicare Part B beneficiaries will pay a higher income adjusted premium.

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Determine When You Will Use Medicare Part A

If you are in your 60s, you should be thinking about when you will sign up for Medicare Part A coverage, keeping in mind that this is also triggered by beginning Social Security benefits. If this occurs when you are age 65 and 1/2 or older, you are in the danger zone of having retroactive coverage applied. If this is the case, you will want to work backwards 6 months to plan your HSA accordingly. Will the 6 months fall within 1 tax year? Or is it possible that the 6 months will straddle 2 different tax years? By my count, the latter could affect HSA decisions you make up to 18 months in advance of enrollment!

Medicare Initial Enrollment Period

If you are receiving a Social Security check prior to age 65:

• Social Security automatically enrolls you in Medicare Parts A and B, and
• Social Security mails you a Medicare card.

If you are not receiving a Social Security check:

• You will need to sign up for Medicare in person at a Social Security office or online at ssa.gov/medicare.

Medicare charges a lifetime penalty of 10% for each 12-month period you are eligible for Medicare Part B but do not sign up for it.

The penalty does not apply when you are enrolled in an employer health plan. See Working Past Age 65.

To have your Medicare coverage effective the month you turn 65, sign up as soon as you are eligible. When you enroll during the last four months of your Initial Enrollment Period, your Medicare coverage is delayed.

See below for more details.

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How To Manage Your Hsa With Medicare Part A

Given the fact that Medicare Part A can retroactively disqualify you from being HSA eligible, it is best to prepare for such an event and plan accordingly. This involves a combination of 1) knowing if you are at risk for retroactive coverage and 2) planning your preceding and current HSA actions appropriately. As such, we recommend the following:

How Do I Use The Part B Sep

To use this SEP you should call the Social Security Administration at 1-800-772-1213 and request two forms: the Part B enrollment request form and the request for employment information form . Youll complete the Medicare enrollment application and give the request for employment information form to the employer to fill out. You want to request additional copies of form L564 from Social Security if youve been covered through more than one job-based plan since you qualified for Medicare.

If an employer is unable to fill out the form, Social Security may accept the following items as evidence you had job-based coverage:

• Income tax forms showing you paid health insurance premiums
• W-2s or pay stubs showing pre-tax medical insurance premiums withheld
• health insurance cards with a policy effective date
• explanations of benefits or
• statements or receipts showing you paid health insurance premiums.

You should write down what you talk about with Social Security, and keep copies of the enrollment forms you submit in case you need to follow up. If your enrollment request is denied, youll have the chance to appeal.

People 65 and older only qualify for this SEP if they have coverage through their own or their spouses job, but disabled individuals can also qualify because theyre covered by a non-spouse family members plan.

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Signing Up For Premium

You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.

After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.

When Does The Medicare Part B Penalty Apply

The Medicare Part B penalty applies when you delay Medicare Part B benefits without creditable coverage.

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The video below shows Bob who chose to delay his Medicare Part B enrollment. Shortly after Bob retired at 65, his wife fell ill. Due to her medical costs, Bob decided to delay his Medicare Part B coverage in order to help pay their medical bills. Little did he know, the longer he waited to enroll in Medicare Part B coverage, the more his Medicare Part B late enrollment penalty grew. Watch the video to see how things turn out for Bob.

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How Medicare’s Retroactive Coverage Affects Contributions To Your Hsa

I help people unleash the financial superpowers of a Health Savings Account.

When you enroll in Medicare Part A, your coverage may start retroactively. Here’s what you need to know about this confusing topic if you’re funding a Health Savings Account.

Medicare and Health Savings Accounts have always had an uneasy relationship. Account owners can reimburse qualified expenses – including Medicare premiums, deductible, coinsurance, and copays – tax-free from their Health Savings Accounts, even when they’re no longer eligible to fund an account. But they lose their eligibility to contribute to their account once they enroll in any Part of Medicare.

What complicates this relationship is that coverage for some people who enroll in Medicare Part A, which doesn’t charge a premium to most enrollees, begin retroactively up to six months before they actually enroll. This earlier effective date affects these account owners’ contribution limits in their final year – and sometimes final two years – of their actively funding their Health Savings Accounts.

Retroactive Coverage

This isn’t an issue for most people, whether they’re retired or continuing to work. But it does affect one group: People who are funding a Health Savings Account. And even among this group, only certain people are affected.

How the Retroactive Provision Works

When you enroll in Medicare and don’t have to pay a premium, the retroactive-coverage rule will affect you in one of three ways:

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