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Why is COBRA Only Paying 20% of My Medicare Claim?



I need your Medicare guidance because in December, I was rushed to the ER because of kidney failure caused from stage 4 of prostate cancer which has spread to my pelvic bones.

Because I was working full-time, I took a leave of absence with short-term disability in January for 60 days while receiving my cancer treatment which ended on February 28th.


I was informed while in the hospital for cancer treatment that I had qualified for long term disability and would no longer be part of the company’s health plan since I was not a full-time employee. COBRA would begin immediately.

 I enrolled and paid for COBRA to continue with medical care where I am having cancer treatment. It took 6 weeks to get the paperwork to Social Security for Medicare Part B to begin May 1st which it has since I was not working full-time. Now my nightmare begins!

COBRA is only paying the 20% of medical bills and I was billed the 80% because I was not enrolled in Medicare Part B which has totaled over $40K.Please help me solve this financial nightmare.

Thanks, Robert, Clearwater, FL

Why is COBRA Only Paying 20% of My Medicare Claim?

Hello Robert,

Those reading this article need to realize the seriousness of Medicare and insurance rules!

The Medicare & You handbook discusses topics such as “Special Enrollment Period” and “Should I Get Part B?”  It states that COBRA is not considered “coverage” based on current employer benefits. 

You have 8 months to sign up for Medicare Part B without a penalty if you are not “working full-time or have lost your company benefits, whichever comes first.”  The 8-month period will run whether you choose COBRA or not. COBRA has an 18-month benefit period.

If you choose COBRA, do not wait until your COBRA ends in 18 months to enroll in Part B. The COBRA benefit period is longer than the 8-month Medicare Special Enrollment Period, and you may receive the famous “Medicare Part B penalty” which goes all the way back to when you enrolled in Medicare Part A.


Robert, you did everything correctly to enroll in Medicare Part B by contacting Social Security and faxing the CMS-L564 form “Request for Employment Information,” signed by your company’s HR department, and CMS-40B form “Application for Part B.”  Fortunately, at least, you were still within the correct time limits for your Medicare Part B to begin May 1st

You are in a Medicare glitch and the COBRA health plan is using “Coordination of Benefits” as their ruling. Chapter 1 of Toni’s Medicare Survival Guide Advanced Edition explains various ways of enrolling in Medicare in detail. Visit for Medicare information.

Group health insurance plans are state-regulated, not a Medicare-regulated plans. Since you are past 65 and already enrolled in Part A, the health plan is passing 80% of the doctor/medical bills on Part B to Medicare. You were not enrolled in Medicare Part B from March 1st to April 30th for Medicare to pick up the difference. 

A bit of good news is that COBRA plans are a creditable prescription drug coverage plan, and you are eligible for a Special Enrollment Period of 63 days to enroll in Medicare Part D plan without receiving a Part D penalty. Please enroll in your Part D prescription drug plan ASAP!

Remember, with Medicare what you don’t know WILL hurt you! Need Medicare help, then call the Toni Says Medicare hotline at 832-519-8664 or email for help.

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Originally published May 17, 2023

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