This may be one of the most important articles for Medicare beneficiaries to read. Email, text messages and many other modern-day technologies have reduced the need for snail mail however, everyone with a mailing address still receives a ridiculous amount of junk mail. Those in the senior age group can confirm they receive an unreasonable amount of solicitations, awards, sweepstakes, political material, surveys, junk, spam, and scam to make you want to just give it up altogether but alas! We cannot.
The Social Security Administration (SSA), Center for Medicare and Medicaid Services (CMS) will not be calling you any time soon. They communicate by snail mail. It is a fact that much of the junk is intentionally designed to masquerade as important, urgent material possibly stating that you may go to jail if you don’t respond immediately, send money or something to that effect. Because of this you might be inclined to just throw all that junk out or set it aside for later review. That is a bad idea. For Medicare beneficiaries who are on a Medicare Advantage, Supplement or Part D Prescription Drug plan this could cause undue stress and even financial hardship. CMS requires that beneficiaries pay the premiums for these health and drug plans. Non-payment is one of the few reasons a person may be disenrolled from their plan. CMS allows for a two-month grace period and the latest date which insurance companies can receive payment according to CMS rules is 30 days from the end of that two-month grace period. Meaning that an individual would have at most 90 days before disenrollment from the plan without recourse. Most Medicare beneficiaries have the premium for plans withheld from their social security income automatically. This prevents missing payments, at least one would think.
Earlier this year there was a glitch in the Social Security Administration and Railroad Retirement Board beneficiary programs which stopped the automatic premium payments for many. We know this because we have had Medicare clients contact us for assistance after the insurance company disenrolled them for non-payment. After this occurred, we then received notice from some insurance companies that there was a problem with payments from these agencies. Insurance companies are sending out notices to inform individuals of the lapse in payment and the urgent need to get the premiums caught up or the danger of being disenrolled from the plan.
In speaking with an insurance company recently, we were told once the premium payment goes past the 90-day period the only reason they will reinstate the plan is if the there was a provable mail theft, fire, flood or other act of God. This is set by CMS rules not the insurance companies. Simply stating that you were unaware of the deadline for any other reason will not work. Personally, I think it is borderline criminal to treat our seniors with such rigid rules and regulations that may place them in financial jeopardy!
Once disenrolled, you will be without health or prescription drug coverage until the next enrollment period. In most cases that will be the Annual Election Period, which is between October 15th through December 7th annually but, this will not be effective until January 1st the following year! There may be exceptions for those who qualify for a Special Enrollment Period but disenrollment for non-payment does not qualify. You may file an appeal, but I am not confident this will work.
The financial ramifications could be severe depending your health situation. For instance, a beneficiary who depends on insulin and was dropped from a drug plan would be without insurance coverage for this critical medication. The price of insulin without insurance coverage runs between $300 and $500 per month. In another scenario, if a beneficiary was dropped by his health insurance company and only had original Medicare and then was admitted to the hospital, the deductible under Part A would cost $1340. For those on a fixed income, either scenario could be devastating.
To avoid this from happening to you, sort through your mail. Take the necessary action for anything that comes from Social Security, Medicare (CMS), any other government agency and specifically your health insurance company. Make sure you know which company you are enrolled with because seniors receive solicitations from so many. If on a Medicare Advantage plan, you will have only one insurance company. If on a Medicare Supplement and a Part Prescription Drug plan, then you may have two insurance companies. We always tell our clients if they are unsure whether mail received is important, to bring it in for us to review. Here are some additional resources: Health Insurance Counseling & Advocacy Program www.hicapservices.net, American Health Insurance Program www.AHIP.org , LOEL Center www.LoelCenter.net 209-369-1591, Lodi Senior Citizens Commission 209-333-6891, your local churches, and family members. Until we talk again, read your mail and be well!