Covering the Bases: Contact Social Securty to request equitable relief

I turned 65 in June of last year. At that time, I went to the Social Security Administration to enroll in Medicare Parts A and B. I have paid Medicare taxes since I arrived in the U.S. in the late 1980's. I am a U.S. citizen originally from Eastern Europe; I speak English but with an accent.

During my interview with Social Security, I tried to convey that I carry insurance through my former employer. The employee at Social Security informed me that "since you have employer insurance, you do not need to enroll into Medicare Part B." Based on that advice, I declined Medicare Part B.

It was not until I received a bill from my physician's office did I realize that my retiree benefits pay secondary to Medicare and that I am required to have both Medicare A and B for full coverage. I contacted Social Security to correct the situation. I was informed that I could not enroll into Part B until next year's General Enrollment Period and that I would incur a penalty.

I keep copious notes of my interactions (especially with governmental officials). I have the name of the Social Security employee with whom I spoke, the date we spoke, and the advice provided. I was clearly misinformed by this employee; what is my recourse?

Your situation appears to be a case of human error. It seems the Social Security employee misunderstood your situation. He inferred you carried active employee health insurance. Active employee health insurance does allow a person to defer enrolling into Part B. In actuality, you carried retiree health insurance and needed to enroll into Part B at age 65.

As a result of the misunderstanding, you were erroneously advised to delay enrolling into Medicare Part B. It appears you have grounds to request "equitable relief."

Equitable relief is a process to request immediate (or retroactive) enrollment into Medicare Part A and/or Part B. Equitable relief determination may also eliminate the late enrollment penalty. For Social Security to grant equitable relief, it must be determined that you received "unintentional, inadvertent or erroneous" information and that this was a result of "error, misrepresentation or inaction" of a Social Security employee.

I would suggest you write a letter to Social Security describing your interactions with Social Security in June of last year. Your detailed notes are critical to documenting your case. Include the name of the Social Security employee who advised you; the date you spoke; the advice provided. Describe the outcome of your interaction with Social Security, that you declined Part B when it was critical that you enroll into Part B to have full health coverage. Clearly state if you want your Part B to be effective retroactively (going back to last June); or if you want your Part B to become effective from this point forward.

Be forewarned, if Social Security reinstates you into Medicare retroactively to June of last year, you will be responsible for the monthly premiums in arrears. Clearly state that you want any late enrollment penalties eliminated.

You are advised to keep a copy of your letter requesting equitable relief. Social Security does not have a required timeframe to respond to your request. If you do not receive any notice within three months, you may need to request the assistance of your local State Health Insurance Assistance Program (SHIP).

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging & Disabilities. SHIP assists people with their Medicare-related questions; SMP assists people with issues related to Medicare fraud. You may contact either program by calling 410- 222-4464 or [email protected].