Couple’s Medicare coverage threatened

At the end of August 2014 man who reached the age of 65 in April 2014 contacted the Ombudsman office for help maintaining Medicare coverage for himself and his wife. Because the man and his wife have very little income, they do not have the money to pay for the monthly Medicare Part B premiums. There is an option called the Qualified Medicare Beneficiary program (QMB), through which the Medicaid program pays the Part B Medicare premiums of $104.90 each month for a couple with a monthly income of less than $1,293. If Part B Medicare premiums are not paid, the couple will lose their Part B coverage. He did not want to lose coverage and came to the Ombudsman for assistance.

The Ombudsman contacted staff at the Montgomery county Department of Job and Family Services (MCDJFS) and spoke to a supervisor about the couple’s dilemma. The staff person learned that there was a discrepancy in the man’s name between the Medicare records and the Medicaid records. The man had provided his given name for his Medicare application, but had provided his nickname for the QMB application. Therefore the system could not process the QMB application because of the difference in the man’s first name. The name was corrected by the staff at the MCDJFS. However, the staff person also learned that the man needed to scan in his Medicare cards at the MCDJFS so that verification could take place that the names match the Social Security Award Letters. The man took the Medicare cards that afternoon to be scanned and the staff person sent an emergency request for processing.

The following week the information arrived that the couple’s QMB application had been approved for September and going forward, but that the application going back to April was still pending. In the meantime, the couple received a notice from the Social Security Administration that their Part B had been terminated for failure to pay. They had 60 days to appeal during which their Part B coverage would continue. The coverage from April to the present was approved the following week and the couple’s coverage was not interrupted.

The Ombudsman Column, a production of the Joint Office of Citizens' Complaints, summarizes selected problems that citizens have had with government services, schools and nursing homes in the Dayton area. Contact the Ombudsman by writing to the Beerman Building, 11 W. Monument Avenue, Suite 606, Dayton 45402, or telephone (937) 223-4613, or by electronic mail at ombudsman@dayton-ombudsman.org or like us on Facebook at "Dayton Ombudsman Office."

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