Why this 68-year-old cancer patient cannot enroll in Medicare Part B
Scarlet Poulet (right), pictured with wife Nadine Kujawa, before Poulet was diagnosed with cancer in 2019.
Courtesy: Scarlet Poulet
Medicare’s rules for signing up have put 68-year-old Scarlet Poulet in an unenviable situation.
The New Orleans resident, who is recovering from cancer, has been enrolled in Medicare Part A (hospital coverage) since 2018 when she reached the eligibility age of 65. Yet due to how Medicare interacts with insurance through an employer — coverage she lost in August — Poulet is now not allowed to sign up for Part B (outpatient care) until January.
That’s when a three-month enrollment window opens for beneficiaries who didn’t enroll when they were supposed to. Even then, however, Poulet’s Part B coverage would not start until July due to Medicare rules — and she could face life-lasting late-enrollment penalties.
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“The rules surrounding Medicare eligibility, particularly as it relates to employer-based coverage, is unnecessarily complicated, with quite unfair results in some situations, like this one,” said David Lipschutz, associate director and senior policy attorney for the Center for Medicare Advocacy.
For most of Medicare’s 63.3 million beneficiaries, long delays before coverage begins or late enrollment penalties are not typical. However, for individuals who have insurance elsewhere when they reach age 65, mistakes in following the enrollment rules exactly can be problematic at best and costly at worst.
A bill that cleared Congress last year called the BENES Act fixes the type of seven-month lag Poulet faces between Part B enrollment and its start date, but it doesn’t take effect until 2023. At that point, coverage will begin the month after a person enrolls.
However, the legislation does not specifically address the issue that led to Poulet’s predicament.
What went wrong
In Poulet’s case, signing up for only Part A made sense at the time — she was covered through wife Nadine Kujawa’s workplace health plan. And, the rules allow beneficiaries to delay Part B without penalty if they have coverage elsewhere that Medicare considers acceptable.
The problem arose when Kujawa resigned from her job to care for Poulet — who was diagnosed with a rare head and neck cancer in 2019 — and the couple remained on Kujawa’s insurance as allowed under the Consolidated Omnibus Budget Reconciliation Act, or COBRA.
That law permits workers to stick with their health plan for up to 18 months (sometimes longer) when they leave a company, although they must cover the full cost of premiums instead of the employer chipping in.
Unfortunately, under Medicare rules, everything changes once the insurance is not related to active employment. It’s confusing and trips up a lot of people.
David Lipschutz
Associate director and senior policy attorney for the Center for Medicare Advocacy
While the work-based plan was suitable in lieu of Medicare Part B for Poulet while her wife was working, Kujawa’s separation from employment automatically rendered the coverage…
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