News

A Challenging Medicare Issue

July 11, 2016

The general rule in Social Security Disability cases is that a claimant becomes eligible for Medicare 24 – 29 months after the date of disability onset. The question arises when the award of Social Security Disability occurs 36 months after the date of onset. What happens to medical bills incurred during the preceding seven months? Are they or can they be covered under Medicare?

The answer is a positive answer but does have certain twists and turns to it. The brief answer is that the Social Security Disability recipient will be given the option to pay past due Medicare premiums out of his or her past due benefits. If he or she chooses to do this then the bills incurred during the preceding seven months should be submitted.

However, BEWARE that medical providers are not happy with a submission of these old bills. Medicare has some strange rule that make most medical providers think it is too much trouble to file. Suffice it to say that Medicare is messy in this regard but the solution is simple. If the client wishes to take the Medicare payments out of their past due benefits and the medical providers refuse to submit it to Medicare for reimbursement, then the Social Security recipient can submit the bill themselves and go around the medical provider.

Disability recipients should be advised to request itemized statements from the medical providers and contact Medicare directly to submit the outstanding bills. In short, claimant’s can buy back to the first Medicare eligibility month by paying the premiums.

For example, if the disability onset date is July 1, 2010 and the Medicare waiting period ended July 1, 2012 but the favorable decision was not issued until June 1, 2013, the Social Security recipient has the choice of taking Medicare prospectively from the date of the decision or the recipient can buy into Medicare and pay the monthly premiums beginning January 1, 2012 and then have the bills that were incurred after January 1, 2012 submitted to Medicare.

In the face of mounting medical bills, some medical practitioners have advised the Social Security recipient to think about bankruptcy. We caution against this because if the back benefits are put into an account these back benefits lose their exemption from the bankruptcy proceedings. These back benefits are not exempt for a Chapter 7 bankruptcy. In a Chapter 13 bankruptcy these back benefits may be required to be used to pay creditors.

The better option is for the Social Security recipient to pay the back Medicare premiums and get the past bills covered by Medicare. Unless the bills are exorbitantly high the premium that is to be paid may well be worth getting the bills covered.

In closing, while some providers are reluctant to submit the bills to Medicare, in this situation we have found that there are many providers who are usually overjoyed to apply for the Medicare payment because they probably are not getting paid on these bills anyways.

Ultimately, if the Social Security Disability recipient paid for the bills themselves, when the provider receives the money from Medicare the provider is required to refund the payments made by the Social Security Disability recipient. Thus the exercise should be to total the premiums that are past due in order to be covered by Medicare and determine if it is worth to get the previous bills covered.