What Would Happen If I'm Awarded Medicare Retroactively?

Sep 15 2020 - 8:18am

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 (date when SSA determined that I received letter from SSA that I am eligeble for benefits) --I am planning to be covered by Obama care (ACA). What are the consequance of that? Would I be able to start Medicare without any penalties on the date of the actual award date (instead of retroactive 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 (full premium) 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 (as they are secondary to medciare for those days)? Are there any good options I have? Thank you very much for your help and the excellent service you provide to the community.


Wow, that sounds like a lot a what ifs. Most importantly, the answer to your question about whether or not you could opt not to enroll in Part B of Medicare retroactively is yes, provided that you would owe more than 6 months of retroactive Part B premiums if you chose to start your Part B coverage with the earliest possible month (https://secure.ssa.gov/apps10/poms.nsf/lnx/0600805195). If your Social Security disability (SSDI) claim is processed more than 6 months after your Part B coverage could have started, you could either choose to start your coverage effective with the month your claim is processed, or retroactively effective with the earliest possible month of Part B eligibility. There would be no late enrollment penalty either way, but you'd need to pay the retroactive premiums if you choose retroactive coverage.

Part A of Medicare would be awarded effective with the earliest possible month of entitlement, regardless of when your claim is processed. Your Part A coverage would be premium free if you're awarded SSDI, so you couldn't refuse any retroactive Part A coverage. If either Parts A or B of Medicare are awarded retroactively, Medicare would pay for any covered medical services in the retroactive period that they would have payed under normal circumstances. If those services were already paid by you or another insurance company, Medicare could reimburse either you or the insurance company accordingly.

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

Best, Jerry