Celebrating 11 years as a Medicare Specialist, October 2019
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Hi there!
As daily life continues to shift in response to the Coronavirus outbreak, I hope you are staying safe and healthy.
This newsletter covers how you can appeal a Part D (prescription) late enrollment penalty. We also share a great recipe for cauliflower fried rice.
Keep reading!
Theresa Cangemi CSA, CLTC
"The Medicare Lady™"
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How can I appeal a Part D late enrollment penalty?
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When you are eligible for Medicare and NOT enrolled in a Medicare Part D (prescription) plan. You could be charged with a late enrollment penalty.
What is this penalty, and what can I do about it?
For each month you
delayed
enrollment in Medicare Part D, you will have to pay a Part D late enrollment penalty (LEP), UNLESS you:
- Had creditable drug coverage, meaning coverage that is as good as or better than the basic Part D benefit. Creditable drug coverage would come from a group health insurance plan, when, the employer prescription plan has been determined to be as good as or better than a Medicare prescription drug plan.
- Qualify for the Extra Help program.
(
This program is based on income and helps you with the cost of your
prescriptions drugs. You can apply and qualify through the Social
Security 1-800-772-1213
).
- Prove that you received inadequate information about whether your employer had drug coverage that was creditable.
To learn how the penalty is calculated,
click here.
In most cases, you will have to pay that penalty every month for as long as you have Medicare (meaning lifetime). There are some exceptions:
- If you receive Extra Help, your penalty will be erased.
- If you are under age 65 and have Medicare, your LEP (Late Enrollment Penalty) will end when you turn 65. Like getting a new start or reset.
- If you qualify for a State Pharmaceutical Assistance Program (SPAP), it may pay your penalty for you. To find out if your state has an SPAP, how it works, and how you can apply, contact your local State Health Insurance Assistance Program (SHIP) by calling 877-839-2675 or visiting www.shiptacenter.org.
of everything.
If you do not have an appeal form from your plan, you can also use
this form.
Unfortunately, being unaware of the requirement to have prescription drug coverage is unlikely to be a successful basis for your appeal. However, the following are good reasons to appeal and may result in the elimination or reduction of your penalty:
- You have Extra Help (see definition of program above).
- You had creditable drug coverage during some or all of the time period in question.
- Call your former insurance plan and ask for a letter proving that you were enrolled in creditable drug coverage. Make sure to attach this letter to your appeal form. Your employer or union (H/R Dept or union representative) may also be able to confirm the fact that you had creditable drug coverage.
- You had non-creditable drug coverage, but your or your spouse’s employer or insurer told you it was creditable or didn’t inform you that it was not creditable once you were Medicare eligible.
- You were ineligible for Medicare prescription drug coverage (e.g., if you were living outside the U.S. or you were incarcerated).
- You could not enroll into drug coverage because of a serious medical emergency.
The appeal deadline is 60 days from the date you received the letter informing you about the penalty.
If you miss this deadline, you can write a letter explaining why you had a good cause, or a good reason--like serious illness--that prevented you from appealing on time. Attach this letter to your appeal. Once your appeal is submitted, you can expect a determination from MAXIMUS within 90 days. In the meantime, pay the LEP to your Part D plan along with your premium. If your appeal is successful, your plan has to pay you back for the LEP payments you made while your appeal was pending.
Keep copies of everything.
This article was taken from the Medicare Rights Center
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Healthy Cauliflower Fried Rice Recipe
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Ingredients
- 2 cups of riced cauliflower
- 2 tbsp of toasted sesame oil
- 2 egg whites
- ½ cup of frozen peas
- ½ cup of frozen carrots
- ¼ cup of frozen corn
- ¼ cup of chopped onions
- 2 cloves of garlic, diced
- 3 tbsp of low sodium soy sauce, more to taste
Directions
- Heat a large skillet over medium low heat, and add 1 tbsp of sesame oil (I like using olive oil).
- Sauté the onions, garlic, carrots, peas, and corn until the onions are translucent and the garlic is fragrant, but not burned.
- Add the remaining sesame oil, the soy sauce, and cauliflower and cook for
5 to 6 minutes, stirring regularly, until the cauliflower rice is tender-crisp
(lightly crunchy on the outside, but still soft inside).
- Make a well in the center of the skillet, and add the egg whites, scrambling as they cook before combining with the rest of the ingredients.
- Serve immediately with optional additional soy sauce to taste.
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* This article is for information purposes only. I don’t recommend, support, or diagnose any featured writer or article. I am not a doctor. Your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.
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