Contact your local Congressperson for help with Social Security/Medicare

on Jan 9, 2025

Toni:

Last week’s Medicare Part D question was from Tonya regarding discovering that she and her husband are receiving an “extra” Part D premium, which she never knew about. You advised her to contact her local Congressional office to help appeal the Medicare issue.

I now must fight Social Security because they are under the impression that I have waited past my 8-month window to enroll in Medicare, which I did not. I did turn in my forms to the local Social Security office within the correct window, but that local office has lost my paperwork and will not accept what I have because they say it is past the enrollment window. I am now receiving a Part B penalty. What a nightmare! Can you please explain what one should do to get help from your Congressperson in appealing an inaccurate decision about Medicare from a local Social Security agent?

--Evelyn from Conroe, Texas

Hello Evelyn:

If you need help with rectifying your Social Security and Medicare issues, then talk with your area’s Congressional office. Because Medicare and Social Security are federal programs, not a state-related program, your Congressional office is the one to help you solve your issues with a federal government issue such as Social Security, Medicare, IRS, VA or other federal programs. Visit your Congressperson’s website for the local office contact information or you can email that office your issue from the website.

Page 19 of the 2025 Medicare & You Handbook under “Should I get Part B?” discusses the rules of leaving employer’s benefits when you are “still working” past 65. It discusses when to delay enrolling in Part B and what employer’s benefits are considered current coverage.

During a Toni Says Medicare consultation, the Medicare team informs those who are retiring past 65 that the Special Enrollment Period (SEP) begins the month they lose employer benefits or employment ends. Many enroll in Part B with a big surprise, finding they are penalized 10% each year, or 12-month period, they could have had Part B but didn’t. The penalty goes all the way back to the day they turned 65 or the day their Part A began.

Below are a few of the Social Security forms used for Medicare: (Don’t forget to write on the top of specific forms CMS-L546, CMS-40-B and SSA-44, “Special Enrollment Period” when turning the forms into the local Social Security office in your area or emailing your forms to the email address which the Social Security representative has given you.)

-- CMS-L564-Request for Employer Benefits: This form shows proof of employer health benefits from the specific employer. If you have had 2 or more employers since turning 65, have a CMS-L564 form signed by each employer to turn into Social Security when applying for Medicare Part B.

-- CMS-40B-Application for Enrollment in Medicare Part B: This form is the application for enrolling in Medicare Part B (medical insurance) Attach this form with the CMS-L564- (Request for Employer Benefits) when applying for Part B after leaving employer benefits past 65 and 90 days.

-- SSA-44-Medicare Income-Related Monthly Adjusted Amount - Life-Changing Event: Form advises Social Security of a major life-changing event and your income has lowered. Life-changed events can be married, divorced, death of a spouse, stopped working or reduced hours, lost property, pension plan stopped and more options on the SSA-44 form.

-- CMS-1763: Request for Termination of Premium Medicare Part A (hospital) or Part B (medical). Form for stopping Medicare Parts A and B when needed. (Does not need SEP written at the top of the form.)

Evelyn, you should pull together any documents and any evidence you have to prove you did not wait past your 8-month window to apply for Medicare after leaving employer benefits. Have them ready to show or send to a representative from your Congressperson’s office.

Readers, remember to always have Part B in place when leaving your job or losing your company benefits. There might not be a second chance!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com.