I received a call the other day from my office saying a desperate and confused couple had come in needing some help with their Medicare Part D coverage. The office told me the plan was not covering one of their expensive drugs! It did not take long for me to realize the mess was bigger than a simple phone call could resolve so I set an appointment to meet with them. I had no idea what I was walking into!
At the appointment I started asking questions as I usually do, trying to understand what the issues were, and how they had evolved. I found out that the wife was on Medicare as of the beginning of the year due to coming off her husband's insurance. Let's just say she is over 70 years old now. Apparently, she had decided to try to handle her insurance on her own over the phone! I don't want to generalize here, but most people coming off a group insurance and going onto Medicare should not be handling the process on their own! You will see why as I continue with this horrific story.
I found out that she was enrolled into a Medicare Part D drug plan, and the plan was covering her expensive brand drug. The problem is that the drug cost over $400, and as most agents know that is going to land you into the Coverage Gap. Of course she knew/understood nothing about this. In fact, she thought the plan quit covering her drug. Just a quick aside here. Whoever the genius was that thought up the Coverage Gap should be required to go around the country giving lectures explaining it to seniors!
As I begin to dig further I found that she had received a letter back in February from her plan saying that she did not have "creditable drug coverage" for the last six years and if she did not provide proof of "creditable coverage" within 60 days that she would be paying an additional $20/month which equates to $240/year. The not so funny thing about this was that the husband went to get a file at my request and right in the front of the file was the proof of creditable coverage from his previous employer. I called the plan immediately, and of course was told that since the time had expired it was out of their hands, and that I would have to go through an appeal with Medicare. Oh, the insanity. If only they had used a good independent, knowledgeable agent!
Anyway, where there's one termite there's usually another or something line that. I started asking about their supplemental coverage, and of course they didn't know what they had or what they had done. I uncovered a letter that was sent from an insurer saying that she had applied for a Medicare supplement plan N, but was missing a simple form in order for processing to complete. I immediately called the company, and of course, you guessed it. No coverage was in place! They never received the form so it was never put into place.
I don't have room here to go into the measures that I did to help them, but it was extensive, and it took several hours. The point? Well, sometimes you can do more damage than good when it comes to Medicare. Could you get burned by an unscrupulous agent? Certainly! Can you do more damage handling it yourself? Absolutely! The more complicated your situation, the more you need help! Find yourself a truly independent agent who has your best interest in mind.
P.S. If you receive something in the mail regarding your insurance, you might want to open it, and then take the appropriate action!
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