Column: What should I do if I get a surprise Medicare bill?

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.

How to deal with Medicare billing and enrollment mistakes

Barb: My mother was a resident in an assisted living home. She later was hospitalized, moved to skilled nursing, and died.

After she left assisted living, they continued to order drugs for her on three dates, billed her Medicare Part D plan, and sent me a bill for the copays. I sent both the drug company and the assisted living home letters stating that she was not responsible for these copays as she was not residing at the location at the time of the order. Today, I received another statement for balance due. I bet this happens to people a lot.

Phil Moeller: I’m so sorry to hear about you mom. Under the circumstances, it’s cruel and unusual punishment to get hounded for these payments. Rather than letters, I would call the assisted living facility and ask for this charge to be dropped. There is no guarantee it will do so, of course, but a little unpleasantness on the phone is preferable to either paying their bill or having them mess with your credit record by referring the matter to a collection agency. If they persist, I’d call the Part D plan and dispute the claim. The insurance company shouldn’t want to pay for these drugs any more than you do.

Lastly, I’d call a Medicare advocacy group to see if someone there is interested in taking up your cause. The two primary groups that I’ve worked with are the Medicare Rights Center and the Center for Medicare Advocacy.

Richa – New York: I am 73 years old, still working full time, and always have been covered by my company’s full health plan. When I turned 65, I applied for my Social Security and at that time I declined enrollment in Medicare Part B. I had surgery this year and, for the first time, received a summary notice statement from Medicare.

I called Social Security and was told that its records list me as having enrolled in Medicare Part B in 2011! I have never signed anything to enroll myself in Part B, and I have a time-stamped letter from Social Security from 2010 confirming my wish not to enroll in Part B. How do I change this and recover the thousands of dollars in improper Part B premiums that have been withdrawn from my Social Security payments?

Phil Moeller: If someone is receiving Social Security benefits, the agency automatically enrolls them in Medicare when they turn 65. After all, it doesn’t know if such people are still working and have health insurance. While this process has certainly created a big problem for you, it would be an even larger a problem if the agency did not do this. Can you imagine how many people would then assume they have Medicare only to discover they weren’t enrolled and had no coverage?

The good news is that you are on solid ground here in appealing and eventually recovering these charges. The bad news is that it can take time and lots of persistence. Make an appointment at your local Social Security office. Bring your paperwork, especially that time-stamped letter. If you do not get relief, let me know, and I’ll look into this further for you.

Dana: I have just taken over the role of helping to manage the finances of my aging parents. One of the first issues we are dealing with is Medicare Part B and Medicare Part D coverage. My father has been a member of a hospital board for many years. A benefit to board members was group coverage under the hospital employee plan, which covered both my father and my mother as a dependent. This benefit is being taken away soon.

When my parents signed up with Social Security at age 65, they were told that because they had coverage under a group policy, they did not need to sign up for Medicare Part B coverage at that time. Now, as we are trying to enroll them for Medicare, we are being told they are not eligible for coverage until July because they did not sign up when they were first eligible. Is there anything that we can do to help my parents? Any advice is greatly appreciated. Unfortunately, I am not sure where to turn. Medicare is much more complicated than I ever imagined.

Phil Moeller: It is not clear from your note whether the coverage your parents had was related to a group policy for active employees or for retirees. If it was for active employees, your parents deserve a special enrollment period and their Medicare should take effect soon. If this is the case, their employer plan needs to sign this form to attest that they have had employer coverage since turning 65. If it turns out that their plan was a retiree plan, then I think Medicare is correct in saying they should have enrolled sooner and that their Medicare effective date is July.

Getting all of what’s yours from Social Security

Lisa – New York: I am 62, unmarried, and have custody of 13-year-old twins. I lived with their father, who is also 62, for 10 years but we were never married. Can I collect any Social Security benefit on his account for myself or the children?

Phil Moeller: In terms of spousal benefits–-for those married or divorced–Social Security bows to state laws in terms of recognizing common-law marriages and eligibility for Social Security benefits. You should be able to find out the rules in New York by calling your local Social Security office.

If you are eligible for a spousal benefit, you should be aware that your former spouse most likely would either have had to file for his own benefit first or you need to have been separated for at least two years before you would be eligible for a spousal benefit.

In terms of benefits for your children, the children’s father would have to file for their own Social Security benefit, thus qualifying the kids for child benefits until they are 18 or 19 (depending on when they would get out of high school). You could trigger their eligibility by filing for your own Social Security but doing so would lock in lower benefits for you for the rest of your life.

Before doing anything, make sure you understand whether an ex-spousal filing would also trigger your own filing for retirement benefits. These provisions are covered by Social Security’s “deeming” rules, which were made more unfriendly to early filers in the big changes to filing laws enacted in late 2015.

Charlene – California: If someone goes back to work after beginning to receive Social Security benefits, can their benefits increase?

Phil Moeller: Social Security bases benefits on a person’s 35 highest earnings years. If you go back to work and earn enough to make that year one of your top 35, your benefits would go up. Keep in mind, however, that changing only one year among 35 will not have a big impact.

Medicare dental and vision benefits

Sarah – New Jersey: I am enrolled in a Medicare Advantage plan that includes no monthly premium and only basic dental and eye care. However, I have the feeling that I may need additional care for the latter very soon. What is the best approach here? Pay for a more expensive plan or buy extra care from another Medicare Advantage plan? Can you suggest a way to find the more adequate service?

Phil Moeller: Delta Dental is a leading carrier, so I’d compare them with the most substantial you can get from your Medicare Advantage plan. This will take some time, as Medicare’s online Plan Finder does not provide all the details you need, making it necessary for you to call individual plans.

Unfortunately, I have yet to find a comprehensive dental plan for individuals.