Why did COBRA cost me $40K in clinical fees?

Reader Alert: Quite a few employer benefit team designs terminate the working day you are…

Reader Alert: Quite a few employer benefit team designs terminate the working day you are no for a longer time operating complete-time. Take a look at employer team health care approach regulations and solutions with Medicare if you or your spouse are 65 or older.

I require your Medicare advice simply because this March, I was rushed to the ER since of kidney failure brought about from stage 4 of prostate cancer that has now unfold to my pelvic bones.

Simply because I was working whole-time, I took a leave of absence with brief-phrase disability in January for 60 times even though obtaining my most cancers procedure. Quick term disability finished on March 15 and so I was positioned on prolonged expression disability.

I was educated, even though in the medical center for cancer remedy, that I had qualified for extended expression incapacity and would no for a longer period be component of the company’s health strategy given that I was not a complete-time staff. COBRA would start immediately.

My spouse and I enrolled and paid for COBRA, so that I could go on with health care treatment wherever I am obtaining most cancers cure. It took 6 weeks to get the paperwork to Social Safety for me to enroll in Section B, considering that I was not operating complete-time, and my Medicare Section B started June 1.

Now my Cobra nightmare starts … for the reason that COBRA is only shelling out the 20 % of professional medical/medical professional expenditures and I was billed the 80% mainly because I was not enrolled in Medicare Part B which has totaled over $40K.

Be sure to assistance me clear up this COBRA monetary nightmare … Many thanks, Robert NW Houston


The Toni States crew will do all that we can to aid you resolve this challenge with your $40K Medicare Section B health-related invoice fiasco.

People studying this report require to realize the seriousness of Medicare and coverage guidelines.

The Medicare & You handbook discusses matters these kinds of as “Special Enrollment Period” and “Should I Get Section B”. It states that COBRA is not regarded coverage dependent on present employer added benefits.

You have 8 months to indication up for Medicare Aspect B without a penalty if you are not “working entire-time or have shed your business gains whichever arrives first. The eight-month time period will operate no matter if you choose COBRA or not. If you select COBRA, do not wait around right until your COBRA finishes in 18 months to enroll in Aspect B. This time period of time is past the 8-month time period, and a single will acquire the well known “Medicare Part B penalty which go all the way again to when one enrolled in Medicare Element A.

Robert, you did every thing properly to enroll in Medicare Section B by making contact with Social Safety and faxing the CMS-L564 form “Request for Employment Information” signed by your company’s HR and CMS-40B type “Application for Aspect B.” You were being inside of the proper time limits.

You are in a Medicare “glitch” and the insurance policies program is working with “Coordination of Benefits” as their ruling.

Group wellbeing insurance plan programs are a condition-controlled strategy not a Medicare controlled strategy. Due to the fact you are past 65 and currently enrolled in Medicare Component A, the overall health prepare is passing the 80 percent of the health practitioner/health-related expenses on Aspect B to Medicare. You had been not enrolled in Medicare Element B still to decide up the big difference.

It will take time to straighten this out but there is hope for you. The Toni Says® Medicare group is below to battle for you!

The excellent news is that COBRA programs are a creditable prescription drug coverage programs and you are qualified for a Special Enrollment Period of time for Medicare Aspect D devoid of acquiring a Medicare Aspect D penalty.

Toni King, Medicare creator/advocate is giving a $5 low cost to the Toni Says® visitors on the new 2021Medicare Survival Guide® Advanced ebook at www.tonisays.com. Have a Medicare dilemma? Contact 832-519-8664 or e-mail [email protected]