Can You Help Sort This Out?

Category: 
Feb 8 2017 - 11:30am

Hi Larry and Jerry
I need help! I have been without hospital coverage for 6 months due to an error made by my agent in filing for my spousal benefits. The details are as follows:
In Feb. 2015, (I was 66, my wife 63) we went to the local SS office and applied to have my benefits deferred to age 70 and to begin receiving benefits from my spouse. Receiving Spousal Benefits was still a valid option at that time, and the agent we worked with seemed to be cognizant of the procedure and competent in his work. The next month my wife and I both started receiving benefits from her SS allotment, and mine had the proper amount of Medicare payment taken out. Everything seemed fine, and I also applied for and received a supplemental health insurance policy from United Health Care. This continued for 15 months. Suddenly, in June of 2016, I was informed by UHC that I was no longer eligible for the supplemental policy because I did not meet the requirements of having both parts A and B of Medicare. This prompted many calls to Medicare and Social Security, and over a several month process, finally was told that the problem could only be solved by the local office. We made an appointment to meet with a SS representative and, after a month, luckily met with the same agent that had originally set up our benefits. He immediately recognized what had happened: he had forgotten to rescind my benefits (which I had not taken but was eligible for) when I retired, so it appeared to SS that I was taking from my wife's benefits even though my benefits were higher. It was now just a simple matter of rescinding my "benefits" which were never taken. But... after several more weeks, we were informed that since it was now more than 12 months past the time of the original application, it was no longer possible to rescind my benefits. The agent has been very supportive, bringing his supervisor into the fray, and acknowledging that it was his error, but SS has been unresponsive, claiming that I owe them nearly $6000 in payments over the 15 months that I received from my wife's SS. I and the agent have submitted the proper Request for Reconsideration forms at two different times - mine (sent in August 2016) was refused, his (sent in October, I think) is still pending. All this time I have been without hospitalization or supplemental insurance, and, although I thankfully have not needed it, I have tempted fate much too long. I need some resolution to this ... I should not have to pay the "overpayment" they claim, and I should be receiving benefits on my spouse's account with Medicare taken out. Everything we did was done in good faith and trust in the agent who is now our advocate, but still no action from the government.
Can you help sort out this sordid affair?
Thanks, Don

Hi,

Ugh. Well, I can't solve anything for you, but I can't imagine why you wouldn't currently have Medicare hospital coverage. It sounds like you inadvertently applied to file and suspend your own retirement benefits rather than just filing a restricted application for spousal benefits only. However, either of those applications would include automatic enrollment in Part A of Medicare (Hospital), so you should have at least that coverage. The only issue that I can imagine with Part A is whether your Medicare number should be your own SSN followed by a letter A, or your wife's SSN followed by B1.

Part B of Medicare is the optional part that covers doctor bills and outpatient care. If you enrolled in Part B, you should have that coverage as well, so I'm not sure what's causing your issue with the supplement plan. Maybe it has something to do with the issue of your Medicare claim number as I mentioned above. If you didn't enroll in Part B of Medicare, though, the current general enrollment period runs through March 31st. If you enroll before then, your Part B coverage would start July 1st (https://www.ssa.gov/medicare/).

Sorry I can't be of more help. Obviously, a major screw-up occurred in your case. Fortunately, the SSA rep that you dealt with has recognized the error and assumed responsibility, so hopefully things will all be resolved in your favor in the end. If your reconsideration request is not approved for some reason, be sure to continue on with the appeals process. The next step of appeal is a hearing with an administrative law judge, whom I would think should be willing to make things right.

Best, Jerry