Conundrum and complicated scenario regarding medicare claims for someone who is fully entitled

tk3000

New Member
Hello Folks,
Lately, I have been facing a conundrum and complicated type of situation that one could only attribute to a high level of incompetence and/or disinterest of public employees to deal with any task that fall outside the ordinary (they probably would have to do some search and research, etc).

In reality, it is not my person who is the victim of this never-ending complication and dysfunction while dealing with public employees who work for medicare -- but, for now, I am one who is dealing with it. The victim is my father's ex-wife (like a mother for me, thereof called "mother"). My father is originally from the US, my mother is from Brazil; and they were married for over a decade. Currently both are in their late 70s.

Both my father and mother lived in Brazil, and my mother lived there for basically all her life till recently (moved to the US at beginning of this year [2023] via a green card). She used to come to the US often with a tourist visa to visit though (once a year). On April of 2018 -- when she was already in her 70 -- she was notified by the US consulate that she was entitled to receive social security benefits (small earnings, like U$300) and medicare benefits (was automatically enrolled in medicare part A). There are two major issues and complications that have recently arisen from both her social security and medicare benefits when she started using these benefits (especially medicare).

As pointed out above, she came to the US at the beginning of this year (2023) and then enrolled in medicare part B. It is my understanding that she would have to pay a penalty for have enrolled late. But she should have to pay a penalty of being about 5 years late, since she received the notice from the US consulate of her entitlement to social security and medicare in 04/2018; and not since she was 65 (as is normally the case for people who lived and worked in the US). The penalty being charged goes back to when she was 65, which does not add up since she was not entitled to medicare or social security when she turned 65.

Secondly, since arriving in the US she went to several medical appointment she since in the US and used her medicare card (plus the part F plan that she has). Few months ago, I started receiving bills from claim that had not been paid by medicare. Once I contacted medicare via phone the attendant indicated that her claims have been denied because she was not legally in the US, which is completely insane and makes absolutely no sense whatsoever. I went to the social security adm. building and presented them with all the documents, etc; they indicated that they had fixed the issue on their side, but then stated that I would have to contact medicare via phone to deal with the medicare part of the problem. Ever since, I called medicare twice and the attendant indicated that they would investigate and would get back to me in week both times -- suffice to say, I still have to hear back from them; and continue to receive medical bills regarding her medicare-covered medical appointments.

At this point, I am not sure on how to proceed. Any insights would be appreciated.
 

So frustrating for you. Continue to call medicare until they make a final decision regarding your case. Re submit the unpaid bills again. And again if need be.
 
To be eligible for Medicare at age 65 or older, you need at least 40 Social Security work credits. This generally means about 10 years of work. If you don’t have sufficient credits, your foreign spouse could obtain Medicare only if he or she becomes an American citizen or has lived as a legal resident in the United States for at least five years. But I may be wrong. You need a lawyer who knows this stuff most likely.

If they lived together for those years in the USA sure simplifies it all. If he were a diplomat or Federal employee stationed in Brazil, there may be provisions within the agency. You may be stuck with getting her insurance. Sure, hope not. Illnesses suck.
 

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So frustrating for you. Continue to call medicare until they make a final decision regarding your case. Re submit the unpaid bills again. And again if need be.

I am in the process of doing that. Thanks!
 
To be eligible for Medicare at age 65 or older, you need at least 40 Social Security work credits. This generally means about 10 years of work. If you don’t have sufficient credits, your foreign spouse could obtain Medicare only if he or she becomes an American citizen or has lived as a legal resident in the United States for at least five years. But I may be wrong. You need a lawyer who knows this stuff most likely.

If they lived together for those years in the USA sure simplifies it all. If he were a diplomat or Federal employee stationed in Brazil, there may be provisions within the agency. You may be stuck with getting her insurance. Sure, hope not. Illnesses suck.

While living in Brazil my father did work for foreign company (not Brazilian company) that did transfer him to Brazil in the early 1970s. So, even though, he was living in Brazil he was contributing to social security the entire time. They divorced several years ago. In 2018, she was notified by the US embassy in Brazil that she did quality for social sec. and medicare benefits, so applied and ever since has been receiving social security. So, the fact that she qualifies for social security is well established.

After some time and assistance from my congressman, the absolute non-sense that she was showing on social sec. system -- that she was present in the country illegally -- was resolved. It was really insane that something so absurd and non-sensical could happen for no reason at all. The worst part is that there is no punishment whatsoever to those government employees and we have to go through all that stress and spend tons of time dealing with it for absolutely no reason at all -- only because some of their employees are way too incompetent.
 
Sorry for the late replies. Only recently, by chance, I found about the replies (never was notified).
 


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