How to Request Medicare Equitable Relief

By Patricia Barry

Copyright © 2015 AARP

Equitable relief is an obscure concept that few people have ever heard of. It allows Social Security to investigate cases and reverse decisions if it finds they were caused by a federal employee’s making a mistake, giving faulty information, or failing to give correct information and may result in situations that cost beneficiaries money, especially from

  • Missing the appropriate deadline for Part B enrollment

  • Being hit with Part B late penalties

Federal employees include any official from Social Security or Medicare or anybody acting on these agencies’ behalf, such as a customer service representative or an employee of a Part D plan or a Medicare Advantage plan.

According to the official instruction on this process (POMS HI 00805.170, “Conditions for Equitable Relief”), you may also qualify for relief “if the evidence shows” that you were misinformed by somebody else (such as your employer or insurance company) who in turn had been misinformed by an employee or agent of the federal government. If Social Security investigates and finds evidence that you received faulty information, it can reverse its original decision, allowing you immediate enrollment or reinstatement in Part B and waiving any late penalties.

Be aware, though, that the evidence has to be pretty convincing. Social Security says it doesn’t even consider opening an investigation unless you can provide the name of the official who misinformed you, plus the place and date when the conversation took place. (This situation is where keeping notes about every interaction you have with federal officials pays off.) Therefore, equitable relief is awarded quite rarely. Some people have obtained it only after asking their members of Congress to intervene. But it’s worth a try.

To apply for equitable relief, write a letter to your local Social Security office (call SSA’s main number, 800-772-1213, or TTY number, 800-325-0778, for the address), being as specific as possible about the details. The Medicare Rights Center offers guidance on applying and a specimen letter. Or call 800-333-4114 for a copy.