The underlying issue is does she now qualify for a Special Enrollment Period (SEP) to elect Part B coverage?
In September 2014, her husband became disabled and hasn't worked since then ... Unbeknownst to her, she was eligible for a 60 day SEP at that time to opt for Part B ... However, they immediately went on MassHealth Standard (Medicaid) and also unbeknownst to her, she would also be eligible for a SEP if she ever became ineligible for the Medicaid
coverage.
In December 2014, her husband's disability benefits kicked in which then put them slightly over the income limit for MassHealth Standard ... MassHealth then placed them on (or facilitated) a Mass Health Connector plan which, in their minds, was a continuation of the MassHealth/Medicaid coverage ... At that time, MassHealth
neither told her she only had a limited time to apply for Part B nor that the Mass Health Connector plan was not Medicaid.
In November 2015, she received notice from the Mass Health Connector that her coverage was being terminated from the subsidized plan because
she had coverage though Medicare (even though it was only Part A) ... The termination was effective November 30, 2015 ... This was very confusing to her ... She had coverage for a year and now she doesn't? ... She was also notified that if she wants to continue the coverage with a non-subsidized plan, she'll now have to pay $450+ per month which she cannot afford.
So now, absent an SEP, she'll have to apply for Part B in the General Enrollment Period (January through March) with coverage to be effective July 2016 ... This means she'll be without both Medical and Prescription coverage for six months which could be disastrous for someone in her condition.
If we can help her get approval for Part B by December 30th, we can have her on a supplemental Medicare Insurance plan effective January 1, 2016 that includes Hospital, Medical and Prescription coverage with a $0 monthly premium ... It's just that simple.
There are two SEPs for which we believe she qualifies (she'll need both Medicare Parts A and B to get the supplemental insurance mentioned above) ... Here are the SEP qualification wordings straight from the Medicare.gov website ...
1. I'm no longer eligible for Medicaid. [MassHealth]
Perhaps you could just forward this e-mail (and attachments) to your contact at the local Social Security office to facilitate your discussion?
Any assistance from you
and the Congressman will be greatly appreciated."
Our rationale ...
There has to be somebody in the Social Security office who can approve this woman for Part B coverage ... However, that person will need a "paper trail" for their file to support his or her decision ... And that was the purpose for the above
letter.
The Happy Ending ...
On December 30th, Social Security and Medicare approved her for Part B on to be effective January 1, 2016 ... She'll now have that supplemental insurance plan that will enhance her Original Medicare coverage (Parts A and B) and include Part D.prescription
coverage.
