Unbelievable but True: Medicare Enrollment Penalty

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EDGE Direct occasionally publishes real-life "unbelievable but true" tales about O&P reimbursement, insurance coverage, and other issues. Chris Jones, CPO, sent EDGE Direct a letter, which was written by one of his patients, Cindy Charlton. Her letter, appearing in edited form below, addresses Colorado state representative Diana DeGette (D-CO) about a serious injustice in the Medicare system.

Dear Representative DeGette:

I am writing to you because I feel a great wrong has been made into law, which can and will affect many people who receive Social Security Disability Insurance (SSDI). I am writing you because I am one of those people.

In 1997, I lost three limbs and the left side of my chest to a vicious Streptococcus A bacterial infection. One and a half years into my recovery and rehabilitation, my husband was diagnosed with a very rare cancer, adrenal cortical carcinoma, which took his life.

At the time my husband was diagnosed, I was receiving SSDI benefits. Shortly thereafter, he began receiving SSDI as well, as he was far too ill to work. We were raising children ages two and four, but regardless of my disability and my husband's illness, I felt bad about having to receive government aid. I certainly didn't want to take more than what I felt I needed.

I was contacted by Social Security two years after receiving SSDI, with an option to receive Medicare benefits. Because I felt I was already a burden on "the system," I chose to not receive the benefit and instead pay out of pocket for my children's and my health insurance. I have paid for private health insurance for the past ten years. This year, our premium went up so high that I could no longer afford health insurance for all three of us. I finally sucked in my breath, swallowed a little pride, and took myself down to the Social Security office to enroll for Medicare.

There I discovered that because I didn't enroll in Medicare in 1999, when I was "supposed to," I would be charged a 10 percent penalty for every year I did not receive Medicare-a penalty assessed monthly. Had I taken Medicare when I was "supposed to" in 1999, it would have cost me $96.40 a month. But because I thought I was doing the right thing, my out-of-pocket payment will be $192.80 per month until I am 65 years old. Over the next 13 years, I will pay approximately $15,000 in penalties to Social Security because ten years ago, I thought not taking advantage of our system was a good thing. By the way, no one told me that I would be severely punished for not taking Medicare coverage.

I am still dumbfounded. Not only am I a widow, disabled, and the mother of two minor children, but now to add insult to injury, I am being punished by the very government I was trying to not take advantage of, by paying for as much as I could without help. I ask you, what is wrong with this picture?

I hope that you and your fellow Congresspersons will work vehemently to rewrite this part of the Social Security Act, so that good, unsuspecting citizens don't get caught in this ugly and potentially financially devastating trap.

I am willing to speak with you in person regarding this issue and look forward to your response.

Respectfully,

Cindy Charlton

Editor's note: If you would like to comment on this letter, or send in your own story for inclusion in a future issue of EDGE Direct, please send an e-mail to