United States District Court, W.D. Washington, Seattle
Honorable Richard A. Jones United States District Judge
matter comes before the Court on Plaintiff Andrew John
Tong's Motion for Summary Judgment, Dkt. # 13, and upon
Defendant Secretary of Health and Human Services's Cross
Motion for Summary Judgment, Dkt. # 14. Neither party has
filed a response. For the reasons stated below the Court
DENIES the Plaintiff's motion and GRANTS the
Defendant's the motion.
Andrew John Tong wants to terminate his Medicare enrollment,
challenging the most recent step of this prolonged process:
the decision by the Medicare Appeals Council (“the
Council”) that Mr. Tong must remain enrolled in
Medicare Part A until October, 2019 and must pay two months
of outstanding premiums for his Medicare Part B coverage.
Dkt. # 1; Administrative Record (“AR”) 15-16. Mr.
Tong claims that he is unable to use alternative insurance
while he remains enrolled in Medicare. Dkt. # 1, ¶ 8.
Tong is a veteran of the United States Armed Forces. AR 34.
He was injured while serving and was therefore entitled to
Social Security disability benefits, also known as SSDI.
Id. at 5, 34. Based on his receipt of SSDI, Mr. Tong
also began receiving Hospital Insurance under Medicare Part A
and Supplementary Medical Insurance under Medicare Part B.
Id. at 5.
April 4, 2011, Mr. Tong began working for Alaska Airlines,
work that disqualified him from receiving Social Security
Disability benefits. Id. at 71-74. While his work
disqualified him from SSDI, the Social Security Agency
informed Mr. Tong that he had been granted a trial work
period, for nine months after he began working- from April,
2011 through December, 2011. Id. at 73. The SSA
further explained that Mr. Tong was eligible for an extended
period of eligibility for three years after his trial work
period, beginning in January, 2012, and ending in December,
2014. Id. After December, 2014, the extended period
of eligibility would end if Mr. Tong's income reached a
predefined monthly amount, thereby qualifying as Substantial
Gainful Activity, or SGA. Id. at 74. Finally, in the
same letter, the SSA informed Mr. Tong that while he was no
longer eligible for disability benefits, his Medicare
coverage could continue. Id.
April 13, 2014, Mr. Tong requested that the SSA terminate his
Medicare Part B benefits, effective May 31, 2014.
Id. at 5, 34. In response, the SSA informed Mr. Tong
that he owed $314.70 to cover his Medicare Part B premiums
through June 30, 2014, at which point the SSA would terminate
Mr. Tong's Part B enrollment. Id. at 6. On June
10, 2014, Mr. Tong requested a reconsideration of this
decision, writing: “I asked that Medicare be stopped on
April 8, 2014; it should have been cancelled in March 2014
when you stopped my Social Security Payment.”
Id. (quoting AR 43). The SSA wrote back, informing
Mr. Tong that its initial decision was correct and he still
owed $314.70 for Medicare premiums covering April, 2014 to
June, 2014. Id. (citing AR 44).
10, 2014, Mr. Tong requested the termination of his Medicare
Part A benefits. Id. at 6, 34. The next apparent
communication from the SSA was a letter, dated August 20,
2014, where the SSA wrote that since Mr. Tong was no longer
entitled to Social Security, “we are stopping your
hospital insurance [Part A] coverage under Medicare. Your
hospital insurance coverage ends on the last day of December
2014. Please destroy your Medicare card after the coverage
ends.” Id. at 6 (citing AR 48). This letter is
in opposition to the SSA's current position and all
further communications the SSA had with Mr. Tong.
See Dkt. # 14; AR.
March 9, 2015, Mr. Tong filed a timely appeal with the Office
of Medicare Hearings and Appeals, requesting immediate
termination of his Medicare coverage and arguing that the SSA
was erroneously charging him Medicare Part B premiums for
months after his coverage terminated. Id. at 35. On
May 28, 2015, an administrative hearing was held on Mr.
Tong's appeal. See id. at 34-97. The
Administrative Law Judge (“ALJ”), Judith
Showalter, considered whether (1) Mr. Tong had completed the
procedure for terminating his participation in Medicare Parts
A and B and (2) was required to pay $314.70 in outstanding
Medicare premiums for April 2014 through June 2014.
Id. at 35.
found that Mr. Tong had terminated his Medicare enrollment
under both Parts A and B. Id. at 37. The
ALJ also found that Mr. Tong's Part B enrollment
terminated in June, 2014 and his Part A enrollment had
terminated in September, 2015. Id. at 37. The ALJ
determined that Mr. Tong was entitled to a waiver of any
outstanding Medicare premiums. Id. at 37.
Review by the Council
referred the ALJ's decision to the Medicare Appeals
Council. Id. at 21-22. The Council found that the
ALJ had applied the wrong regulations to Mr. Tong's case,
applying those regulations for premium Hospital Insurance,
which Mr. Tong did not have. Id. at 13. Applying
regulations applicable to free Part A benefits, the Council
determined that Mr. Tong could not waive entitlement to his
Part A Hospital Insurance “without also forfeiting his
entitlement to Social Security Disability Benefits and
repaying the cost of the disability benefits provided to that
point.” Id. at 14. In other words, unless he
was able to repay all SSDI payments, Mr. Tong was required to
remain enrolled in Medicare Part A through the end of
September, 2019. Id. at 14. The Council also found