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Senior Woman looking out of a window

Help! A doctor is ruining my credit with Medicare overbilling

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. Send your questions to Phil.

Sheri – Va.: I was overbilled by a doctor who accepts Medicare. He continues to insist I pay him the difference between what he billed me and what he has agreed to accept from Medicare, even though my Medicare reports [summary notices] clearly show I do not have to pay this extra amount. My problem is that he reported me to Equifax and it has been falsely issuing a negative credit report on me!

I reported this to Medicare twice, and each time someone there said they would do something about it and didn’t. I disputed it through Equifax four times and each time this doctor gets my evidence, which is the Medicare summary statement showing I do not have to pay the amount he is currently reporting to Equifax.

I have contacted the state medical board, as well as the state agency for Medicare that’s supposed to handle this, and whose people are paid by Medicare to handle this. I don’t think I’m going to get any result from either one of them. Now, if someone can destroy my credit legally and get away with it, I can only wonder what else is going on in the United States.

I am permanently disabled since 2005, and on Social Security disability plus Medicaid, which pays all of my Medicare premiums. I drive a car about to croak and have maybe 10 cents left at the end of each month. Then along comes a joker going wild with Medicare and destroying my credit, which forces me to pay higher interest rates on my credit cards.

I feel like I don’t really live in America anymore, and in fact I’ve been lied to at the worst time in my life, when I’m older and not able to fight back the way I used to. Do you think it’s possible they’re counting on the older generation to just give up?

Phil Moeller: I wish Sheri’s note to me was an isolated event. It’s not. More and more of my Ask Phil questions are coming from people who say they’re being dropped from state Medicaid rolls or say their problems are being ignored by Medicare and Social Security. More ominously, I think things are poised to get much, much worse.

I am watching, along with the rest of the country, as the Republican-controlled Congress proceeds to enact a major tax bill. The odds of major changes appear high after the Senate’s approval of its version of the bill last week by a 51-49 margin. No Democrat voted for the measure, and only one Republican defied the party with a ‘no’ vote. The House of Representatives has a solid Republican majority, and President Trump is calling for a bill he can sign as soon as possible.

Virtually every liberal group and think tank, including major senior groups, say these changes eventually will lead to cuts in health care and possibly Social Security. They predict serious erosion of a social safety net whose construction began more than 80 years ago during the New Deal.

For Sheri and countless more, that erosion is already occurring. Living in America increasingly seems to many like being in one of those third-world places where the deck is stacked against ordinary people. Let your Congress members know about your problem. Even if help seems unlikely these days, at least they will be hearing that times are tough.

JC – S.D.: I’ve been trying to convince my sister that she will be eligible for a widow’s benefit even though she’s been divorced from her elderly husband for many years. The marriage lasted more than 30 years.  I’ve finally convinced her that she can go ahead and collect on his earnings record (when she’s reached her full retirement age) and should take it if it is larger than she would receive at 70 based upon her own earnings.  But she just won’t accept the fact that she will also be eligible for widow’s benefits, too, when the day comes.

Am I not correct? Also, if she takes her own Social Security at 70 and he later dies can she then switch over to his benefit, assuming it’s larger? I can’t seem to find supporting info on the Social Security site.  Can you cite a location that spells this out?

Phil Moeller: You are correct, assuming she did not remarry prior to age 60. If she did not, she can file for a survivor benefit as early as age 60, although it would be subject to early filing reductions if she files before her FRA.

Still, this could be the best course of action if her ex-husband dies before she turns 70. Let me explain.

Social Security rules allow people to file for survivor benefits while also permitting them to defer filing for their own retirement benefits until those benefits reach their maximum amount at age 70.

So, your sister could file for her survivor benefit and collect it until she turns 70, and then switch to her own retirement benefit.

If her retirement benefit is going to be larger at that time than her survivor benefit, she will come out ahead by filing for her survivor benefit as soon as she is eligible. I’ve done the math, and if you know you are going to switch to your own retirement benefit at age 70, accepting a reduced survivor benefit for a longer number of years is better than waiting until the survivor benefit reaches its maximum amount at FRA.

However, if her survivor benefit at FRA is going to be larger than the retirement benefit at age 70, then it’s best to hold off filing for the survivor benefit until FRA, and then to simply keep collecting that benefit for the rest of her life.

Lastly, if he is still alive when she turns 70 and begins her own retirement benefit, she would be eligible for an increased benefit when he dies, assuming her survivor benefit is the larger of the two.

David – Nevada: I’m turning 65 next January. For the past seven years, I’ve had group health insurance from my fiancé’s employer. I would like to keep that plan until she decides to retire and then get Medicare. Will I get penalized then for late enrollment? Remember, she’s not my spouse.

Phil Moeller: In a word, yes. Social Security says its rules require a couple to be married in order to qualify as having had group health insurance, and thus avoid Medicare’s late-enrollment penalties.

Sorry. Maybe you should get hitched!

Lailoma – Va.: My birthday is Sept. 15, 1953.  When do I need to apply for Medicare?

Phil Moeller: Medicare enrollment periods can be complicated! If you are not actively employed with employer health insurance, you will have a seven-month initial enrollment period for Medicare. It will begin three months before your 65th birthday, and include your birthday month and the succeeding three months. In your case, you can apply for Medicare as early as June of next year.

If you are still working and have employer health insurance, you would not need to sign up for Medicare until you leave that job, even if you are older than 65 when that occurs. This rule applies to workplaces with 20 or more employees. If you worked for a smaller employer, you would still need Medicare when you turned 65.