Paralegal Judy Bledsoe of my office recently received a call from a client of mine who had been approved for disability benefits, but was having Medicare problems.  My client was a longtime employee of a local phone company and continued to receive health insurance coverage through a company plan even after she stopped working because of her disability.

When my client was approved for SSDI, she also became eligible for Medicare.  SSDI claimants become eligible for Medicare 25 months following the onset of their disability.

Here, my client’s eligibility for Medicare started in approximately September, 2004.  However, in order to get the Medicare coverage, my client had to pay the Medicare premium from September, 2004 through the present.  She could have paid this premium from her lump sum past due benefit award. Her future Medicare premium will be deducted from her monthly Social Security payment.

Because my client’s medical bills had been paid by her health insurance company, she declined to pay for the past due Medicare premium.  Recently, however, the health insurer discovered that my client had become eligible for Medicare, they advised my client that they intended to contact all of the doctors and hospitals who they had paid to ask for their money back since Medicare was the primary insurer.  Further, the health insurer advised my client that if she was unable to figure out a way to "undo" her rejection of Medicare coverage from September, 2004 to the present, she would end up responsible for all the medical bills.

My client has used up her lump sum and does not have the approximately $3,000 that would be needed to pay the past due Medicare premium.  If the health insurer recovers its payout for medical services, my client will owe over $10,000.  I am going to contact Medicare to see (1) if my client still has the option of paying her Medicare premium for the past due months and (2) would Medicare consider allowing her to pay her premium at $50 to $75 per month, automatically deducted from her monthly Social Security benefit payment.

The lesson learned from this situation – if you have a health insurance policy in place and you subsequently become eligible for Medicare, Medicare appears to be the primary payor.   Be very careful, therefore, about waiving your right to Medicare coverage for pre-existing months.

[tags] Medicare, medicare and private health insurance, past due benefits Social Security Disability [/tags]