CMS Expands Eligibility for Time-Limited Equitable Relief from Part B Penalites

This week the Centers for Medicare and Medicaid Services (CMS) expanded those beneficiaries eligible for time-limited equitable relief from Part B penalties to people who are in Marketplace plans and missed signing up for Medicare Part B during their Special Enrollment Period following the loss of their or their spouse’s employer covered health insurance. CMS had previously just offered this equitable relief to those who had Medicare Part A and a Marketplace plan and delayed enrolling in Part B without knowing the costly consequences of later enrolling in Part B and incurring a lifetime late enrollment penalty. This has been an easy mistake to make, as little to no information is given to people 65 and older who are currently covered by an employer health plan, or to people approaching 65 who have their own insurance in the Marketplace about the consequences of delaying Part B enrollment. Then, when later enrolling into Medicare Part B, these people have found themselves with a substantial late enrollment penalty and gaps in coverage.

Last September, CMS extended the timeframe to apply for equitable relief for an additional year, ending September 30, 2018. The equitable relief is in the form of a waiver for Part B late enrollment penalties and a Special Enrollment Period to sign up for Part B.


Who can apply?

You should apply if you qualify for premium-free Part A AND you became eligible for Medicare on or after April 1, 2013, but did not enroll in Part B during your Initial enrollment period and, instead, stayed in your Marketplace plan.

You should apply if you could have enrolled in Medicare Part B during your Special Enrollment Period following the loss of your or your spouse’s employer health insurance, but instead chose to enroll in a Marketplace plan.

Also note that:

  • If you are NOT enrolled in Part B, the equitable relief gives you a Special Enrollment Period to enroll. You can ask for up to 2 months retroactive enrollment, though you’ll need to pay the Part B premiums for those months.
  • If you already enrolled in Part B but have a late enrollment penalty, you can apply for relief from the penalties.
  • You can apply for this relief regardless of whether you had qualified for Marketplace subsidies (advance premium tax credits, or ATPC).


How do I apply?

Call your local Social Security office to make an appointment to apply in person at 1-800-772-1213. This is the quickest way to make sure you can utilize this equitable relief. Remember, the deadline is September 30, 2018.

When calling, make sure you say you want to use the time-limited equitable relief to enroll in Part B and/or eliminate the Part B late enrollment penalty (LEP). Also state that you were enrolled in both premium-free Part A and a QHP. If you already have Medicare Part B and just want to have the Part B LEP waived, you must specifically state that.

For your appointment, you will need to bring proof of your enrollment in a Marketplace plan. You can also bring a Medicare Part B enrollment form (Form CMS-40B). Some examples of proof include:

  • A Marketplace eligibility determination notice (can be accessed via your Marketplace account)
  • IRS Form 1095-A that demonstrates your months of coverage and/or subsidy amounts
    Marketplace premium invoices and proof of payment
  • Receipt of your first premium payment that activated your Marketplace enrollment


Where to go for help


Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.