Martinez Class Members Provided Medicare Part B Protections

June 14, 2010

Author: Catherine M. Callery (Kate) | Louise M. Tarantino

Thanks to Martinez class counsel, the Social Security Administration (SSA) has agreed to remedy a problem facing certain class members trying to get back into Medicare Part B.  Martinez is the national “fleeing felon termination” class action case.  (See January 2010 Disability Law News for discussion of Martinez v. Astrue decision and related article on page one of this newsletter.)

Although fleeing felon terminations for Social Security Disability (SSD) recipients do not result in a comparable disqualification for Medicare purposes, some class members were unable to keep paying their Medicare Part B monthly premiums when they lost their SSD cash benefits.  SSA eventually terminated their Medicare Part B coverage due to failure to pay premiums.  (Part A coverage for SSD recipients is free and therefore should have continued uninterrupted.)  Low income beneficiaries should not have been affected if they were enrolled in a Medicare Savings Program, which pays the monthly Part B premium for people with incomes at or below 135% of the federal poverty level.

When SSA retroactively reinstated SSD cash benefits under the provisions of the Martinez settlement, those recipients who wanted to get back into Medicare Part B were told (1) they had to wait until the next general enrollment period and (2) they would be assessed a late enrollment penalty (a higher monthly premium) to boot!  (The Part B General Enrollment Period is between January 1 and March 31 of each year, to become effective July 1st – there is no coverage for medical expenses incurred July 1st.)

Fortunately, Martinez class counsel successfully challenged SSA’s practice, and SSA has agreed to use its “executive discretion” to automatically enroll members back into Part B without applying any waiting period, and also to waive any premium penalties.  Class members can opt out of ongoing or retroactive coverage.

The National Senior Citizens Law Center, part of Martinez class counsel, will be sharing more details on SSA’s implementation policy as it becomes available.  In the meantime, if you have questions about Medicare for Martinez class members, or other Medicare or Medicaid questions, please feel free to contact Cathy Roberts at the Empire Justice Center at croberts@empirejustice.org or 518 462-6831.  For more information on the Martinez settlement, visit the National Senior Citizens Law center website at http://www.nsclc.org/front-page/areas/social-security-ssi/Martinez-Settlement.