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Sunday, July 14, 2024 | Back issues
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No Exit From Medicare for Those on Social Security

WASHINGTON (CN) - Retirees cannot opt out of Medicare Part A, which covers hospital stays, unless they are willing to forfeit their Social Security checks and repay all of the benefits they have already received, a federal judge ruled.

Because of their access to alternative coverage, in this case Medicare, a group of retired federal employees said they could not elect to pay for the superior health insurance plan afforded to federal employees.

The retirees sued the Department of Health and Human Services to void regulations that make it mandatory for recipients of Social Security to be enrolled in Medicare Part A.

U.S. District Judge Rosemary Collyer, rather reluctantly, said her hands were tied. "Medicare costs are skyrocketing and may bankrupt us all; nonetheless, participation in Medicare Part A is statutorily mandated for retirees who are 65 years old or older and are receiving Social Security Retirement benefits," Collyer wrote. "Whether Congress intended this result in 1965 or whether it is good fiscal and public policy in 2011 cannot gainsay the language of the statute and the regulations."

For its part, HHS argued that the retirees were not being harmed by the mandatory Medicare coverage. Even if they were allowed to decline the coverage, they wouldn't receive greater benefits from their federal plan, the government said.

Collyer agreed noting that, by statute, even if the retirees "were to forego and repay all Social Security retirement benefits, their FEHB-paid benefits would be no more, and no less, than what Medicare Part A would provide." (FEHB refers to federal employee health benefits.)

Using Medicare Part A reimbursements as the ceiling for what the federal employee health insurance would be allowed to pay is a cost-control mechanism for the federal employee health program. It also keeps hospitals and other institutions from charging more for non-Medicare Part A patients, according to the HHS.

The problem comes over the word "entitlement." The retirees argued that entitled does not mean "must accept," while HHS argued that Part A coverage cannot be declined unless retirees also decline the retirement benefit since the plan is triggered in statute by applying for retirement benefits.

Collyer agreed, saying that Congress meant for the entitlement to be a mandatory benefit because it choose to link coverage with retirement benefits.

As a result, she wrote, "Plaintiffs are trapped in a government program intended for their benefit. They disagree and wish to escape. The court can find no loophole or requirement that the secretary provide such a pathway."

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