October 19, 2021

Wv Health

Health Simplified

Why did COBRA price me $40K in healthcare bills?

Reader Warn: Numerous employer profit team plans terminate the working day you are no longer doing work comprehensive-time. Check out employer group professional medical prepare rules and possibilities with Medicare if you or your spouse are 65 or older.

I will need your Medicare guidance because this March, I was rushed to the ER simply because of kidney failure induced from stage 4 of prostate most cancers that has now spread to my pelvic bones.

Because I was doing the job total-time, I took a leave of absence with limited-time period disability in January for 60 times although getting my most cancers therapy. Brief term incapacity finished on March 15 and so I was positioned on lengthy phrase disability.

I was informed, while in the hospital for cancer remedy, that I had capable for very long term disability and would no longer be element of the company’s health and fitness approach given that I was not a total-time worker. COBRA would start out straight away.

My wife and I enrolled and compensated for COBRA, so that I could continue on with healthcare treatment where by I am owning cancer therapy. It took 6 weeks to get the paperwork to Social Protection for me to enroll in Section B, since I was not working full-time, and my Medicare Component B started June 1.

Now my Cobra nightmare commences … because COBRA is only paying out the 20 % of professional medical/medical professional expenses and I was billed the 80% simply because I was not enrolled in Medicare Aspect B which has totaled over $40K.

Remember to support me solve this COBRA economic nightmare … Many thanks, Robert NW Houston

Robert:

The Toni States staff will do all that we can to help you fix this trouble with your $40K Medicare Portion B medical monthly bill fiasco.

These studying this post require to notice the seriousness of Medicare and coverage guidelines.

The Medicare & You handbook discusses subjects these kinds of as “Special Enrollment Period” and “Should I Get Portion B”. It states that COBRA is not regarded as coverage based mostly on recent employer rewards.

You have 8 months to indication up for Medicare Element B without the need of a penalty if you are not “working entire-time or have missing your enterprise benefits whichever will come initially. The 8-month period of time will operate whether you opt for COBRA or not. If you opt for COBRA, do not wait around until eventually your COBRA ends in 18 months to enroll in Portion B. This time period is past the eight-thirty day period period of time, and a single will acquire the famed “Medicare Portion B penalty which go all the way back again to when a single enrolled in Medicare Portion A.

Robert, you did almost everything appropriately to enroll in Medicare Element B by speaking to Social Safety and faxing the CMS-L564 kind “Request for Employment Information” signed by your company’s HR and CMS-40B kind “Application for Part B.” You were in the proper time boundaries.

You are in a Medicare “glitch” and the coverage system is applying “Coordination of Benefits” as their ruling.

Group well being insurance designs are a condition-regulated strategy not a Medicare controlled strategy. Because you are previous 65 and already enrolled in Medicare Component A, the well being program is passing the 80 per cent of the medical doctor/medical expenditures on Element B to Medicare. You were being not enrolled in Medicare Element B nonetheless to decide on up the difference.

It will consider time to straighten this out but there is hope for you. The Toni Says® Medicare crew is listed here to battle for you!

The good information is that COBRA options are a creditable prescription drug coverage designs and you are qualified for a Unique Enrollment Period of time for Medicare Aspect D devoid of receiving a Medicare Element D penalty.

Toni King, Medicare creator/advocate is offering a $5 discounted to the Toni Says® audience on the new 2021Medicare Survival Guide® Advanced reserve at www.tonisays.com. Have a Medicare question? Phone 832-519-8664 or email [email protected]