LF: Americans Who Opt Out of Medicare Must Forfeit Social Security Benefits

Title: Americans Who Opt Out of Medicare Must Forfeit Social Security Benefits
Source: Breitbart
URL Source: http://www.breitbart.com/big-govern ... feit-social-security-benefits/
Published: May 31, 2016
Author: Dr. Susan Berry
Post Date: 2016-05-31 19:04:10 by cranky
Keywords: None
Views: 19792
Comments: 77

Unelected bureaucrats recently proposed the imposition of a new rule that would affect all Medicare Part B providers and nearly all Medicare drugs. Such bureaucrats, however, have been operating for years, forcing Americans onto government-run healthcare under pain of loss of Social Security benefits.

Most adults in the United States who turn 65 go onto the government-mandated health insurance program known as Medicare – the program liberal and socialist Democrats hope will universally cover all Americans some day soon.

Seniors who choose to opt out of Medicare and continue to purchase their own private health insurance plans, however, are punished by the federal government for doing so by being forced to forfeit their Social Security benefits, even though they may have paid into the Social Security system for many years.

Medicare and Social Security have been linked together since 1993 when unelected bureaucrats in the Clinton administration wrote a rule that states seniors cannot opt out of Medicare without giving up their Social Security benefits.

In 2008, a group of seniors, who formed an organization called The Fund for Personal Liberty, filed a lawsuit – Hall v. Sebelius – in which they argued that the applications for Medicare and Social Security are voluntary and independent of each other. These Americans had all contributed to Medicare and Social Security throughout their employment histories, but wished to continue to purchase private health insurance once they reached age 65. They asserted that they should be able to opt out of Medicare – government-run healthcare – without forfeiting their Social Security benefits, and that forced participation in Medicare violates the right to privacy.

The Fund wrote:

The Medicare Lawsuit challenges the idea that unelected bureaucrats can create policies that act as law. Nowhere in the Medicare and Social Security statutes will you find a provision that a person who wishes to avoid Medicare shall be denied Social Security benefits. That is a penalty of approximately $250,000.

The case proceeded for several years and hit its most alarming obstacle in March of 2011, when U.S. District Judge Rosemary Collyer – former general counsel of the National Labor Relations Board – who initially had sided with the plaintiffs, suddenly reversed herself, ruling in favor of the Obama administration instead.

In an earlier ruling in the case, Collyer acknowledged that, “neither the statute nor the regulation specifies that Plaintiffs must withdraw from Social Security and repay retirement benefits in order to withdraw from Medicare.”

In her stunning reversal decision, however, the judge ruled that “requiring a mechanism for plaintiffs and others in their situation to ‘dis-enroll’ would be contrary to congressional intent, which was to provide ‘mandatory’ benefits under Medicare Part A and for those receiving Social Security Retirement benefits.”

Collyer also asserted in her decision that the Obama administration “extols the benefits of Medicare Part A and suggests that Plaintiffs would agree they are not truly injured if they were to learn more about Medicare, perhaps through discovery.”

“Plaintiffs are trapped in a government program intended for their benefit,” she continued. “They disagree and wish to escape. The Court can find no loophole or requirement that the Secretary provide such a pathway.”

Regarding the decision, Kent Masterson Brown, the lead attorney representing the seniors in the case, commented at the time:

Anyone concerned with what will happen when the bureaucrats start writing the thousands of pages of rules that will govern the ‘Patient Protection and Affordable Care Act’ need only look at what has happened in Hall v. Sebelius. When they do, they will realize nothing will be optional and there will be no fair, affordable or swift manner to obtain recourse or appeal a decision made by the bureaucracy.

After the ruling, which essentially decided that an entitlement program such as Medicare is “mandatory,” then-Sen. Jim DeMint (R-SC) introduced the Retirement Freedom Act. The bill would have allowed Medicare and Social Security to be “disconnected,” so that Americans would be free to opt out of government Medicare health insurance, but still retain their Social Security benefits. The bill, nevertheless, died in the Senate.

Meanwhile, the members of the Fund appealed their case to the U.S. Supreme Court. In 2012, the Cato Institute and the American Civil Rights Union (ACRU) joined the case as well and submitted amicus briefs. However, in January of 2013, the Supreme Court denied the appeal, a decision the Fund stated was “the easy way out.”

“The three branches of government all have the ability to reign in bureaucratic overreach, but none have the fortitude to do so,” wrote the Fund. “When unelected bureaucrats create mandates out of thin air, without any repercussions, we have opened Pandora’s Box.”

Have you read the article and some of the relevant posts on this thread? The answers are right there. HINT: It's so because the courts say it is so because that is the intent of Congress that made the law and Clinton who signed it. At least read post #17.

The case was explicitly decided on the merits — the Court found there were none. The Court stated, "plaintiffs have it backwards. Signing up for Social Security is a prerequisite to Medicare Part A benefits, not the other way around."

You seem fixated on the pre-trial proceedings regarding standing and a pre-trial motion for summary judgment which could have denied the right to a trial altogether. The Court found standing to exist -- that there was a right to proceed to trial. Simply showing a right to proceed to trial does not connote a showing that the party will win at trial where the merits are judged. They only showed sufficient evidence that there had been some particularized injury.

The appellate court found that the pre-trial question of standing had successfully been overcome. The appellate court then announced they would proceed to address the merits of the case.

What plaintiffs sought was a judicial declaration that they were not entitled to Medicare Part A benefits, binding upon their private insurers.

Plaintiffs sought a judicial declaration that they were not entitled to Medicare Part A benefits. The Court found, properly, that they were entitled to such benefits by statute. The requested redress is beyond the legal autority of the Court.

Paintiff Armey is former Congressman Dick Armey. He apparently chose the gold standard BCBS plan.

Plaintiff is apparently a USPS worker, a mail handler, who apparently chose the NPMHU plan sponsored by the National Postal Mail Handlers Union.

What the plaintiffs requested was impossible under prevailing law. They are over 65 and entitled to Social Security benefits. They are, therefore, automatically eligible for Medicare Part A.

Therefore, the requested redress for the claimed injury is impossible under law, and the plaintiffs have no right to receive it.

What the plaintiffs actually seek is to have their private insurer pay more. They are eligible for Medicare Part A, and are not entitled to a court declaration saying they are not eligible.

I should think they are better off, payment-wise, with Medicare Part A and private insurance secondary. Medicare would pay the lion's share of what is deemed to be the allowable amount. Federal BCBS would pick up almost the entirety of the remainder. For the mail handler, he is a retired civil service employee and his retirement check is the responsibility of, and comes from, the Officer of Personnel Management, not the USPS. Uncle Sugar pays about 80% of the insurance premium. The better policies, such as Federal BCBS (and I believe NPMHU), include prescription payment, making Medicare Part B unnecessary.

In the case of the brain surgery that ran about 300,000, using fictional made up figures, Medicare may have capped its maximum authorized payment at about $200,000. Depending on how the doctor/providers associated with Medicare, he/they may be able to claim slightly more than the normal authorization, but that is it for complete claimable compensation. The personal payout is minimal.

In any case, you cannot say you are ineligible for Medicare and cost BCBS additional hundreds of thousands of dollars they are not liable to pay. BCBS is not eligible for paying that which Medicare will pay. Just because a patient does not want to claim payment by Medicare does not make BCBS responsible.

If BCBS were the primary and sole insurer, the providers can charge what they want and the BCBS payout may exceed the Medicare allowed maximum. The BCBS policy is a contract you enter into and you accept that they will not pay what you are eligible to have Medicare pay. This was a failed attempt to make an end run around the private insurance contract that the individual entered into, in order to make the private insurer liable in a manner contrary to Federal law. It did not work and was rejected on the merits.

I do the same thing, I paid medicare for a year or so then I canceled because of my wife's new job. There's a penalty for not paying for Plan B but it's waived if your go off spouses insurance and sign up for Plan B.

At least read the actual Federal law and not some dingbat's misguided nonsense about it. The entitlement has been automatic since 1965.

79 Statutes at Large, 290, Public Law 89-97, H.R. 6675, Social Security Amendments of 1965, (TITLE I-HEALTH INSURANCE FOR THE AGED AND MEDICAL ASSISTANCE)

Become an appellate lawyer, take it to court, and make yourself famous persuading the court that you are right and they are wrong.

There is a reasonable chance that you will be less covered by Medicare than your private insurance or that you will have to change medical providers because they do not accept Medicare. that is the injury that the judge in this case acknowledged for the plantiffs.

SS could have been around since 1789, and in 1965 the CONGRESS decided to bestow Medicare eligibility to all who were receiving SS benefits. How long SS was around does not matter.

The judge was opining in a light most favorable to the non-moving party on a pre-trial matter involving standing.

On the merits, the Court opined that the plaintiffs argument had no merit. Automatic eligibility for Medicare for the plaintiffs had been a matter of statute law since 1965.

Now there is a total irrelevant and off the mark response by you. The fact is Congress tied SS to Medicare when it made the law that one could not refuse Medicare A and maintain their SS. For example, what happened to those that were receiving SS prior to 1965? They had Medicare trusted upon them with the consequence that some, perhaps most, lost some insurance coverage from their private insurance provider. In essence the government told We The People that they can't win, they can't break even and more importantly they can't quit.

Why are you being so dense? Yes, the merit to which the judge was referring was the fact that the plantiffs could not renounce their eligibility for Medicare - EVEN IN LIGHT OF THE FACT THAT THE PLANTIFFS WERE INJURED BY THAT ELIGIBILITY. It is as if the government deliberately set out to reduce the amount of medical benefits seniors can receive by tying Medicare to SS. And the judge said that it was irrelevant that the government injured people in that way. F*ck him and the government for that.

SS is in no way tied to obtainment, signing up for, or eligibility for Medicare.

SOSO #7: "You need to do more research. Bill Clinton signed the operative law. "

SOSO #9: [Quoting a blogger] "While the Social Security law does not require participants to accept Medicare, and the Medicare law does not require participants to accept Social Security, the Clinton Administration in 1993 tied the programs together. Under that policy, any senior who withdraws from Medicare also loses Social Security benefits."

SOSO #17: "HINT: It's so because the courts say it is so because that is the intent of Congress that made the law and Clinton who signed it."

SOSO #32: "The fact is Congress tied SS to Medicare when it made the law that one could not refuse Medicare A and maintain their SS.

You have repeatedly talked about this unidentified law alleged signed by Bill Clinton.

They sought to have the Court declare they were ineligible for Medicare Part A. Pursuant to Federal statute law, they were, in fact, eligible for Medicare Part A. Therefore their lawsuit has no merit.

The law did not reduce their personal insurance benefits. Their insurance company did that. As a secondary insurer, their private insurer will not pay what the primary insurer is required to pay.

The government made people age 65 on Social Security automatically eligible for no-cost health insurance. Medicare puts limits on what they will pay for each procedure. Providers who accept Medicare payments cannot accept more than the Medicare established maximum limit. Providers can refuse to particpate in Medicare.

Private secondary insurers will not pay what the primary insurer is required, by law, to pay. Health care providers must bill the primary insurer first.

The judge said that what they asked for, a declaration that they were ineligible for Medicare Part A, was directly contrary to law and could not be granted.

You tell a good fairy tale about an unidentified law supposedly signed by Bill Clinton, but the court case is clear and simple. The case had no legal merit. They were eligible for Medicare pursuant to U.S. statute law. The Court could not hold otherwise.

The Article 3 case or controversy requirement mandates that the injury will be "redressed" by the remedy being sought. In the lost case, Hall v. Sebelius, the remedy sought was directly contrary to law. The requested remedy was impossible for the court to grant. You do not have a valid case or controversy when the requested remedy is directly contrary to statute law.

Excellent sophistry. Yes, your honor, my client did aim and pull the trigger, but it was the bullet that actually killed that cop.

Then why are you arguing with me as this is exactly my point. The plantiffs suffered injury exactly because they could not escape the limits imposed by Medicare. The judge acknowledged that.

The fact is that most providers that accept Medicare limit their coverage to what Medicare covers and to the amount established by Medicare for a particular service or treatment. That fact is that for many Medicare provides inferior coverage to the private insurance that they have. By forcing Medicare A upon people by taking away their SS benefits the government de facto mandates inferior insurance coverage for those people.

The fact is that when a person becomes eligible for Medicare and Medicare becomes the primary insurer almost all private insurers adjust their coverage to match that of Medicare. In most cases this means that the private insurer reduces the amount it covers whether or not a provider accepts Medicare. For example, I am over 65, have Medicare A, have private insurance, and have the option to enroll in Medicare B. If I do enroll in Medicare B the coverage my private insurance will be limited to what is provided under Medicare B which is less than the coverage I currently have with the insurance company. Further, this is true if I choose a provider that doesn't accept Medicare. In other words, Medicare puts a cap on what my insurance company will cover whether I have it or not. I believe that this is true for almost everyone that has private insurance.

I will ask you one more time, what do you believe our Founding Fathers would think of this government action?

"At the same time, it is within the trial court's power to allow or to require the plaintiff to supply, by amendment to the complaint or by affidavits, further particularized allegations of fact deemed supportive of plaintiff's standing. If, after this opportunity, the plaintiff's standing does not adequately appear from all materials of record, the complaint must be dismissed."

Lastly, as for standing, for all the BS you posted it comes down to the question of whether or not the plantiffs suffered some injury. The fact that the judge didn't even ask the plantiffs for any proof or evidence that they did speaks loudly to the wide spread common knowledge that Medicare provides inferior coverage for many people with private insurance - in other words it was a slam dunk that the plantiffs were injured.

The limits were on what the doctors could charge. The plaintiff's, by law, could only be charged LESS, and Uncle Sugar picked up most of the bill. The Secondary Insurer picked up all, or virtually all, the rest. Medicare eliminates the deductible for a doctor's visit.

You continually misrepresent what was said as a holding of the court. It was a review of an inquiry on standing where the court must accept the allegations as true, in order to determine whether the complainant has alleged facts, which if true, would justify proceeding to trial on the merits. In the proceedings on the merits, those allegations still need to be proven. On the merits, the case failed.

Exactly. That is why some of the better docs decide not to accept medicare. And that is why only the wealthy get care from those better docs.

I guess you do not think that a person is injured when they no longer can get treatment from a better doctor because the government forced them to have to pay more because their existing private insurer no longer covered what that doctor was charging. NB - The private insurance company very likely negotiated a payment arrangement with that specific provider which undoubtedly was lower than the doctor's posted rated to the uber cash paying rich, such as the Kennedys.

Now I agree that the billing practices of doctors and hospitals are a sham. The face value of the services provided to my wife (i.e. - what was billed to the insurance company) for treatment of her brain cancer, from surgery through the present clinical trial, is well in excess of $400,000. After the "discounts" negotiated by my private insurer, the actual payment was less than 30 cents on the dollar and my annual out of pocket cash expense was capped at well less than $8,000. Even though we had Medicare A it was not in the picture because is was still worker and my private insurance was primary at the time of her hospitalization.

I just retired and Medicare A is now my primary for hospitalization and our private insurance secondary. I have not enrolled in Medicare B so my private insurance is still primary for these service. We are hoping that my wife will not need another surgery but if she does I am not at all sure that the combination of Medicare A as primary and my private insurance now as secondary will cover all of the cost ex. my stated annual out of pocket expense.

I am trying to figure out what would happen if we did enroll in Medicare B. It is not at all clear that I would be at least as well covered as when I was not retired. Somehow I feel that we would be screwed.

plaintiffs contend that entitlement to Medicare Part A benefits has thereby been made a prerequisite to receiving Social Security benefits, in contravention of the statute governing entitlement to Social Security benefits. But plaintiffs have it backwards. Signing up for Social Security is a prerequisite to Medicare Part A benefits, not the other way around.

SS is in no way tied to obtainment, signing up for, or eligibility for Medicare.

SOSO #7: "You need to do more research. Bill Clinton signed the operative law. "

SOSO #17: "HINT: It's so because the courts say it is so because that is the intent of Congress that made the law and Clinton who signed it."

SOSO #32: "The fact is Congress tied SS to Medicare when it made the law that one could not refuse Medicare A and maintain their SS.

You have repeatedly talked about this unidentified law alleged signed by Bill Clinton.

I have linked and posted actual law. Where's yours??? What is your phantom law? What is it? What does it say?

I have not enrolled in Part B as my private insurance pays for it. The cost of my private insurance would not be reduced by my paying to have the government cover the cost. I believe BCBS is better and the govt won't screw with that because all the congressmen use it.

As for the lawsuit, you can construe it any which way you want, but the requested remedy was contrary to statute law and the Court was legally barred from providing it. The statement that they were harmed was made assuming their allegations were true, and construing all doubts in favor of the plaintiff. There is no viable claim against Medicare as the law is clear and specific. Any remedy would have to come from Congress, not the Court.

As for docs who do not participate in Medicare (not a penny acceptance of Medicare funds) you should be able to use your private insurer or money. In general, those providers would be expensive.

You missed the whole point of this thread. Upon retirement you automatically become eligible for Medicare A. As a result your private insurance only covers the amount that is determined by Medicare A, even though the day before it was covering a higher amount for you when you were not eligible for Medicare A. You lose coverage. You have to pay more out of pocket. The same is true for what your private insurance will pay to providers that do not accept Medicare. i.e. - it is my understanding that when Medicare is primary by law the insurance company can only pay the Medicare determined amount for a particular service (which may very well be lower than what it was paying the same provider when Medicare was not primary).

If you were already collecting Social Security retirement benefits when you turned 65, you will automatically be enrolled Medicare Part A irrespective of whether or not you have private insurance. Prior to retirement your private insurance is primary and Medicare A secondary. The amount paid to providers is almost always negotiated between the provider and the insurance company - and it is usually above what Medicare A will pay. When you retire Medicare becomes primary. At that time if your private insurance reduces what it pays for a service to what is allowed by Medicare A you are injured just by the fact that Medicare A is considered primary.

This judge ruled that the law is that one cannot reject Medicare eligibility. I am not quibbling with that finding but am outraged with the law.

As for Medicare B vs. BCBS when you retire, I have no idea if you would be better off with just BCBS, with just Medicare B or paying for both. As you noted, most private insurance will cover the deductibles and copays under Medicare. This could be more than the premium paid for the BCBS coverage. To the extent that BCBS pays for services not covered by Medicare B you easily could be ahead of the game by have both coverages. This is what I am trying to determine with respect to my private insurance now that I am retired.

When all is said and done tying Medicare to SS and not allowing a person to be free of Medicare eligibility just screws most retirees by providing a lower level of service or by forcing them to pay more for the same level of coverage.

No, Medicare becomes your primary insurer and pays most of the cost and yor private insurer become secondary and pays the remainder. You pay little to nothing out of pocket.

Thank you for posting this case, nolo chan. As always, I enjoy reading your posts even if we disagree. I love conversing with intelligent people like yourself.

Only up to the amount established by Medicare which I believe is less than what the private insurers pay when they are primary. The net result is that your out of pocket expense increases.

The only duty the Courts have is to determine three things: 1)personal jurisdiction over you, jurisdiction to hear your case, and finally standing to sue not just based on the merits of your case alone. There could be substantive laws of procedure that would compel such a panel of judges to grant review of your case. This may be referred to as Judicial Review possibly by a panel of judges at an en banc hearing.

As this case reads standing was determined on the basis of whether the plantiffs were injured. RE: post #14:

"They claim they would receive enhanced coverage from their private insurers if they were not entitled to Medicare Part A benefits. For purposes of the standing inquiry, we must accept those declarations as true.

We conclude that Armey and Hall have suffered injuries in fact from their reduced private insurance. They have shown causation because their private insurance has been curtailed as a direct result of their legal entitlement to Medicare Part A benefits. And as to redressability, plaintiffs claim that they could obtain additional coverage from their private insurance plans if allowed to disclaim their legal entitlement to Medicare Part A benefits.

Because Armey and Hall have standing, we need not address standing for the other plaintiffs. We therefore proceed to the merits."

Is there any way to read those paragraphs that leads to the conclusion that the judge found that the plantiffs were in fact injured, that the basis for establishing plantiifs standing was that injury, and, that the merits of the case were something other than that injury?

Is there any way to read those paragraphs that leads to the conclusion that the judge found that the plantiffs were in fact injured,

Again, that would be determined by the causation stated in Plaintiff's Complaint concerning that injury.

We first consider plaintiffs' standing. Plaintiffs claim that their private insurers have curtailed coverage as a result of plaintiffs' entitlement to Medicare Part A benefits. Plaintiff Armey declared that his legal entitlement to Medicare Part A benefits led his Blue Cross plan to reduce coverage without a matching reduction in premium. Plaintiff Hall declared that his Mail Handlers plan stopped acting as his primary payer because of his legal entitlement to Medicare Part A benefits. They claim they would receive enhanced coverage from their private insurers if they were not entitled to Medicare Part A benefits. For purposes of the standing inquiry, we must accept those declarations as true. [Emphasis added here]

Actually it does. The reason why is that the judges in this matter relied on the Plaintiff's sworn Declarations that were attached to the Verified Complaints. Not excluding the federal statutes on rules of civil procedures on merits of cases, Declarations are used as part of the Complaint and although they are not incorporated into each paragraph, the Declaration (or sworn Affidavit) as separate from the Complaint, is just as important as the Complaint and stated causes of actions incorporated into each paragraph itself.

I will provide my personal info from April. The figures come straight off my BCBS paperwork.

An MRI had charges submitted by the imaging center for $2,214.00. The Medicare Plan Allowance was $245.51. Medicare paid $148.77. BCBS paid the remainder $96.74. I paid nothing.

Absent Medicare, the bill would have been $2,214.00. Had a private insurer paid 90% (no deductible), that would have left a bill of $221.40.

When the provider participates in Medicare, they agree to accept the plan allowance as full payment, in this case $245.51. If I had no secondary insurer, I could have been billed not more than $96.74 out of pocket.

Because Medicare lowballs the plan allowance so much, the providers increase what they charge others so they can remain profitable. It is not the Medicare patient whose out of pocket expenses increase, it is the non-Medicare expenses that increase.

So you are claiming that the plantiffs lied about having to pay more when Medicare became primary?

Were they required to do that as they stated that they must or did they just accept the plantiffs declarations without further inquiry?

And that's exactly the catch. If my provider of choice does not accept Medicare but had a separate agreement with the insurance company the insurance company would in almost all cases pay more for that provider's service than the Medicare amount. When I then become locked into mandated Medicare the insurance company automatically reduces what it will pay my provider of choice for a particular service. So when I now again go to my provider of choice I will have to pay more out of pocket if I want treatment by that provider. My alternative is to find another provider that accepts Medicare. It's Obama's lie again, "if you want to keep your provider you can......but it may very well cost you."

No matter how you cut it Big Brother is forcing us to take Medicare whether we like it or not. Only the wealthy (including the lawmakers) will be able to afford the provider of their choice and there will only be room for a few them.

OK, your provider accepts Medicare. When my wife was diagnosed with brain cancer we chose our providers on the basis of skill, reputation, recommendations from people in the medical community, etc. AND if they were covered by our private insurance which at the time was primary (though we had Medicare A no Medicare was involved as I still was working).

Medicare did not come into our thinking at the time we chose our providers. Frankly I have no idea if our providers accept Medicare or not. If they do our experience going forward with her treatments may likely follow yours. If not we will likely have to pay significantly more out of pocket OR change providers in mid-stream of long-term treatment. If the latter we will certainly feel that we lost something as we chose our providers very carefully from among of several alternatives - obviously we felt we chose the best providers available to us at the time. Medicare did not enter into the picture. Enter Medicare and we may now have to choose what we view as lesser skilled providers and/or facilities.

And the picture is even more uncertain as we are almost certain to have to find another clinical trial in the not too distant future with Medicare A now our primary insurance. We have been in contact with a few of the most notable doctors in the country to establish a relationship with them when the time comes for us to move on. I have no idea if these most prominent neuro- oncologists and neuro-surgeons accept Medicare. If they don't I don't know if we will be able to afford the treatment. I do know for a fact that Ted Kennedy had no money problems with being able to engage one or more of these doctors to treat his brain cancer.

Dealing with incurable cancer is scary enough not to have to worry about losing some insurance coverage because of a government mandate.

"In its most recent report from 2013, the association found Medicare most frequently denied claims, at 4.92 percent of the time; followed by Aetna, with a denial rate of 1.5 percent; United Healthcare, 1.18 percent; and Cigna, 0.54 percent.'

When Medicare is primary and private insurance secondary, what do the private insurers cover when Medicare denies a claim?