What Kind of Help is That?

April 27, 2009 at 5:38 pm 2 comments

Medicare beneficiaries are fighting back against decades of delays in processing benefits that have caused them to make hard choices between health care and other necessities of life. 

66 year old Narcisa Garcia, a resident of Pennsylvania, lives on $695 a month, just about 75% of the federal poverty rate.  Paying her Medicare Part B premium reduces her tiny income to $599 per month.  Yet Ms. Garcia should not have to pay her Part B premium; she is one of millions of low income Medicare beneficiaries entitled to help from one of the programs that pays for Medicare cost-sharing.  Although she is eligible for benefits from Pennsylvania going back to November 2008, six months later, in April 2009, she is still paying her Part B premium.  Some people may be able afford to float loans to the federal government, but not those living on less than $700 a month.

On April 24th, Ms. Garcia and another Medicare beneficiary, together with two advocacy organizations filed suit against the federal government and the state of Pennsylvania claiming that the harmful and illegal delays in processing enrollments for benefits denied them their rights under federal law. Narcisa Garcia, et al. v. Charles E. Johnson, et al. 2:09-cv-01747 (AB) E.D. Pa. (Complaint filed April 24, 2009). 

The programs to help low-income beneficiaries have existed since the beginning of Medicare and Medicaid, in 1965, but were beefed up in the late 1980s and early 1990s when Medicare cost-sharing increased significantly. For decades, they have suffered from serious delays in processing enrollments that leave people footing their own bills for months or even years after they have been found eligible for the benefits. 

The Center for Medicare Advocacy and the Philadelphia-based Community Legal Services are representing the plaintiffs.

The plaintiffs are asking the court to recognize the case as a class action, to declare the government’s practices illegal, to require that benefits are provided promptly, to notify beneficiaries of delays in processing, and to notify beneficiaries that they might be entitled to a refund of back benefits.  They are asking, in other words, that the programs do what they are supposed to do: help people.

Entry filed under: Help for Low Income People, Medicare.

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2 Comments Add your own

  • 1. Curtis Rushing  |  May 4, 2009 at 4:35 pm

    i’M WONDERING IF EVER WE WHO ARE BEING PENALIZED FOR NOT JOINING MEDICARE WHEN TURNING 65 will ever get charged with the regular premium?? I did not know that I would have to pay more ..I was insured by the state of TExas and I just thought I was being patriotic by not joining…..now I am paying 70% more than others and I have very small SS payment…..soon, I will not get any SS at all , that is if I live long enough and it seems that I am going to be here a long time. I guess I should be happy about that, but, I don’t want to live in deep poverty…Thanks….

  • 2. Denise  |  September 7, 2009 at 4:35 pm

    If a person is working after 65 and have employer insurance, they don’t have to sign up for Medicare. But when they stop working they must sign up for Part B or face penalties. When they apply for part B they must include documentation showing they were insured.

    As for people getting help with their Medicare costs, here in Arizona, it takes from two to five weeks for people to get confirmation from the state that they are eligible. Then the state contacts Social Security so these Medicare beneficiaries get a low income subsidy for their drug costs.

    The system works great here in Arizona, though I run into many seniors who are not aware they should be getting help. I’m an insurance agent and I carry the state forms with me, fill them out with the senior, and deliver them to the local state office. I know insurance agents are supposed to be the bad guys along with insurance companies, but we do lots of outreach and can make seniors aware of benefits they should be getting.

    Also, here in Arizona, there is a Medicare Advantage plan for people who are getting Medicare Cost Sharing and Limited Income Subsidy. The plan has almost no co-pays and provides $1,000 in real dental benefits (per year). I know Medicare Advantage is a dirty word, but this is a great plan for moderate income seniors who don’t qualify for Medicaid. I hope the cuts to Medicare Advantage don’t pull the plug on this plan.


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Health Policy Expertise

We provide effective, innovative opportunities to impact federal Medicare and health care policies and legislation in order to advance fair access to Medicare and quality health care.

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April 2009


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