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What to do if you have been wrongly charged for Medicare

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 “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; and he will answer as many as he can.

Andrew – California: I’ve been wrongly charged for Medicare through Social Security since I was awarded disability benefits in October 2016. Although they’ve recognized their mistake, it’s been 20 months, and they’re still charging me after I’ve been told three times that they stopped! I’m 45 years old and have had health insurance my whole life without interruption. I haven’t used Medicare benefits ever! How do I deal with Social Security? I can’t get answers and there is no personal accountability. Do I have any legal recourse? Please help. I have hungry kids at home.

Phil Moeller: I’m assuming from your note that you were awarded Social Security disability and automatically enrolled in Medicare, but that you don’t need Medicare. I have no brilliant insights here. It sounds like you have been doing the right thing but that no one from Social Security has acknowledged this. There is a form to use to appeal Medicare enrollment decisions. Have you completed this form yet?

Have you called your Congressman’s office? Social Security listens to people on Capitol Hill, and they might be able to help. Otherwise, all I can suggest is that you keep at it.

I wish concerns like yours were few and far between, but sadly they are common. Social Security is a huge but understaffed bureaucracy, and people often feel like bugs trapped in flypaper.

When I formally bring these types of problems to Social Security’s attention, the response invariably is to tell people to get in line by calling the agency or completing a complaint form. Really? The agency needs to do better here. How about an ombudsman’s office that would truly be on the side of beneficiaries?

Meda-Kay – Louisiana: If I have Medicare A and B, through a Medicare Advantage plan, and a commercial policy through work, which policy is primary?

Phil Moeller: If your employer has more than 20 employees, its plan normally continues as the primary insurance when an active employee turns 65. In this case, you should look at the benefits you get from having Medicare as secondary coverage and decide if they’re worth what you are paying. If you do decide to drop Medicare, you can re-enroll at a later date with no problems or penalties. Medicare usually is the primary insurance in smaller employer plans.

Joe – Maryland: I really enjoyed your Social Security and Medicare books. I will reach full retirement age in December 2018. My estimated Social Security benefit will be about $2,500 per month, and I plan to apply at that time. My wife started collecting Social Security at age 62, and she receives $900 per month; she is now 67. When I file, will my wife be eligible for spousal benefits and, if so, what is the process for obtaining them?

Phil Moeller: Glad you like the books! Your wife just needs to call Social Security and claim a spousal benefit. However, because she filed for her own benefits early, her potential spousal benefit was also reduced. As a result, I doubt she would receive much if anything in the way of an additional benefit. However, it never hurts to ask.

READ MORE: What do non-married couples need to know about getting Medicare

Not that you asked, but instead of applying for your own benefit, have you thought about filing a restricted application for just a spousal benefit? The new Social Security rules approved by Congress in late 2015 erased some filing strategies but maintained this one for people like you who were at least 62 years old as of early 2016. Your spousal benefit would be much less than your own benefit, of course, but by doing this you can permit your own benefit to grow by 32 percent if you delay filing until age 70.

Natalie – Utah: My mom has been diagnosed with stage 3 colon cancer and has Type 2 diabetes. She is going to require radiation six days a week and chemo every other week for the next six weeks and then will need help with daily activities such as bathing and dressing. I believe Medicare does cover at-home care services if they are prescribed by a physician or other licensed caregiver, right? I will also need a nutritionist to help with daily meals prepared for her due to her conditions. She only receives Medicare Part A and B benefits. Can you give me any advice?

Phil Moeller: You’re right that Medicare benefits for your mom would be limited to medically required help and not help with so-called activities of daily living. As a result, it’s important for you to work closely with her doctors to fashion their requests as medically required. In the case of a nutritionist, for example, the doctor would have to maintain that she needs special meals because of her condition and that this assistance can only be provided by a nutritionist.

The medical-necessity bar can be set quite high. It also wouldn’t hurt to find an at-home caregiver you like. They must be licensed by Medicare; here is an online tool to find such agencies. If you find one you like, I’d call them to see if they would take on your mom as a client and ask them how your doctor should word the necessary prescriptions.

Gail: I’m a recent widow, age 60. My husband was 66 at the time of his death last May. He was on disability at the time of his death, receiving about $1,870 a month. Social Security told me that I’m not eligible to receive his Social Security until I’m 66 and 2 months since I teach school full time. They said I make too much money to qualify to receive his Social Security. Is this true?

Phil Moeller: Social Security’s earnings test can take a big bite out of a working person’s benefits until they reach full retirement age. I suggest you look at these rules and decide if your earnings are enough to cancel out your survivor payments.

The good news is that the earnings test does not affect benefits once a person reaches their full retirement age. This is also the age at which survivor benefits reach their maximum amount, so waiting until then to file can make sense on two grounds.

I realize this is a long time away for you. In thinking about your best retirement-income strategy, I suggest you spend time understanding whether your survivor benefit would be affected by any pension you receive from your teaching job. If you will receive such a pension, and it’s based on work for which you have not paid Social Security payroll taxes, Social Security’s Government Pension Offset rules could sharply reduce your survivor benefits.

If, on the other hand, you have paid payroll taxes, then the challenge is to calculate which benefit – your own or your survivor benefit – would be larger. Then you can decide what steps to take to maximize that benefit.

Rich – New York: My specialist doesn’t work with my current Medicare Advantage plan. I want to switch to an Advantage plan he accepts for 2019. If my sign-up period to switch plans ends Dec. 7, when will I know if this specialist accepts a new plan?

Phil Moeller: You should be able to find this out before you apply for a new plan. Medicare’s annual open enrollment period begins October 15 and ends, as you note, on December 7.

Plans must have their 2019 provider networks in place no later than October 1. Your specialist should know by then if he is participating in any new plans. If for some reason he does not know, you can use Medicare’s online Plan Finder on or after October 1 to locate 2019 information about plans that are sold in your area. If you find a plan you like, you can contact the plan to see if your specialist is in its provider network.

Glen – Mississippi: I’m 66 years old, and I have stage 4 cancer. I’m still doing chemo yet my case worker from Medicaid tells me I’ve been denied my Medicare Part B premium through the division of Medicaid. What should I do? I need my medical coverage.

Phil Moeller: Battling cancer is hard enough without having to also battle for your insurance rights. Medicaid provides Medicare benefits to lower-income folks, who are then dually eligible for both programs. It sounds like something has changed with your situation or with Mississippi’s Medicaid rules, so that you no longer qualify for Medicaid benefits.

However, you cannot be denied Medicare. You always can pay the Part B premium out of your own pocket if it turns out that you are no longer eligible for Medicaid. I realize coming up with $134 a month (the standard Part B premium) might be tough, but that’s different than being told you are being denied Medicare.

The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and should have someone in a Mississippi office who can help you.