SSA Agrees to Provide Medicare Part B Enrollment Protections to Martinez Class Members

In response to arguments raised by NSCLC and other class counsel, SSA has agreed to use its “executive discretion” to ensure that Martinez class members do not experience a lapse in Medicare Part B coverage as their Social Security benefits are restored.

When Martinez class members who had their monthly Medicare Part B premiums paid out of their Social Security payment lost their cash benefits, they also lost their ability to pay their Part B premiums.  Some class members were able to get their premiums paid by their state Medicaid agency by qualifying for the Medicare Savings Program.  Others may have had sufficient resources to continue to pay their premiums.  But for another group of beneficiaries, the loss of cash benefits meant the loss of Part B coverage due to a failure to pay premiums.

SSA previously indicated that these class members would not be re-enrolled automatically into Part B when payment of cash benefits was restored, but could only re-enroll during a General Enrollment Period between Jan. 1 and March 31 of each year and then wait until July for coverage to commence with no coverage for medical expenses incurred prior to that date.  POMS GN 02613.870A1.  On top of that they faced a penalty in the form of a significantly increased monthly premium for the rest of their lives.  None of this is stated in the notices that people are receiving from SSA.

Fortunately, after class counsel challenged this approach, SSA relented.  Using its “executive discretion” SSA will do the following:

  • Class members who are eligible to enroll in Part B and who are not currently enrolled will be automatically enrolled without the individual needing to take any action.
  • There will be no penalty added to the monthly premium for these class members.
  • Once the automatic enrollment has taken place, class members will be offered the opportunity to “opt out” of Part B coverage (and receive a refund for any premiums paid).
  • Class members will also be provided the option to enroll in Part B retroactive to the Part B termination date.  If a class member chooses a retroactive enrollment date the enrollment must be for the entire time the individual was without Part B coverage.  Class members must pay premiums for each month of retroactive coverage requested.  Class members are not required to pay the entire amount of retroactive benefits in one lump sum.  They can request an alternative method such as monthly installments or waiver of the retroactive premium amount.  See HI 00805.180 and HI 00805.220.  We are awaiting an implementation plan from CMS that will indicate how notice of this option will be provided to class members.
  • Class members who are currently enrolled in Part B and are charged a penalty because of enrollment in a general enrollment period will no longer be charged a penalty.  These individuals will receive refunds for any penalties already paid.  Class members who enrolled in Part B during the 2010 general enrollment periods will retain their current Part B entitlement date of the month of processing and be offered the opportunity to enroll retroactive to the Part B termination date.

As mentioned above, SSA will be providing class counsel a plan that will explain the details of how this new policy will be implemented.  NSCLC will provide updated information as soon as these details become available.

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