The Most Common Issues After Signing up for Medicare
You’ve just finished your last day of work before retirement, you gave yourself plenty of time to sign up for Medicare and get your insurance in place for when you need it to start. In a perfect world there’s nothing else you should have to do except relax and sip cold beverages on a beach somewhere. Unfortunately, that isn’t always the case and you may need to take some additional steps before your Medicare is squared away. At Doctor’s Choice we call these occurrences post enrollment issues and here are some of the most common issues we see and explanations on how to resolve them.
The Part D “Scare Letter”
If you’ve been working past 65 and delayed signing up for Medicare Part B because you were covered by your or a spouse’s employer group plan, there’s a very good chance you’ll receive this letter. Even though you provided proof that you had creditable coverage to Social Security, the insurance companies that you buy Medicare Advantage Plans and Part D plans from don’t see that. They see a gap between you turning 65 and signing up for their plan and send you a letter as a result. This letter will say something along the lines of “prior to enrolling in ‘name of plan’ it appears you did not have prescription coverage that met Medicare’s minimum standards…” The letter goes on to say you’re going to be penalized for not enrolling.
This misleading letter is often stress inducing and rightfully so as, no one wants to pay a penalty for the rest of their life. Luckily, this is often a simple fix. There will be a phone number included with the letter that you can call and provide a verbal confirmation that you did have coverage. Most of the time it’s solved with this phone call. In rare cases, they may request a letter on company letterhead from your former employer confirming the information you provided over the phone. You have 63 days after losing employer coverage to sign up for prescription coverage through Medicare without any penalty, so unless you have had a gap in coverage, don’t pay a penalty that you shouldn’t have to.
Medicare not showing up as your Primary Coverage
While not as common, another frustrating issue that could arise with Medicare is what we refer to as a Medicare crossover issue. This happens when the Medicare system doesn’t update to reflect that Medicare is now your primary coverage. Oftentimes, your old employer coverage still shows up in the system as your primary coverage in these cases. This becomes an issue when you go to the doctor or pharmacy. When your claim is submitted to Medicare it comes back denied leaving people confused and frustrated and rightfully so. In these cases, there is usually nothing that was done wrong, just a simple glitch in the system.
In order to resolve this issue, you will have to call in to the Benefits Coordination and Recovery Center (BCRC) and request a simple termination. This agency manages retiree benefits and the coordination of benefits between health care plans. The script to use when you call is: “I recently received medical treatment and the claim was denied due to Medicare not being my primary insurance. This is not correct. I have been on Medicare since _______ (part b effective date) and am no longer covered under my employer group plan and I would like my records to be updated to reflect this.” They should be able to look into your account and correct the issue for you. In come cases they may inform you that they see Medicare as your primary and a further call to Medicare, your provider or your insurance carrier may be required. Usually a call to the BCRC is all that is needed.
Your Doctor Was Dropped from the Network
This isn’t a common occurrence, especially in an area like Rhode Island where Doctor’s Choice is located, but that doesn’t mean it can’t or hasn’t happened. This situation is especially pertinent if you have a Medicare Advantage Plan. These types of plans utilize a network of Doctor’s that you can receive care from ie: an HMO. These provider networks can change unexpectedly throughout the year. This can be especially frustrating if your Primary Care doctor drops out of the network.
In these cases, you have a few different options. One would be to select a new primary care physician that is still in network. This is not ideal for people who have built a relationship between their primary care doctor but, it provides the most immediate solution. You can call the customer service number on the back of your card or research online (usually) to find in network doctor’s who are accepting new patients. Your Explanation of Benefits booklet may also have a list of in network providers. Another solution would be to wait until the Annual Enrollment Period (Oct 15th — Dec 7th) and enroll into a new plan that your doctor does accept. A third option would be to pay out of pocket to continue seeing your doctor. Your plan may also have an out of network benefit, like a PPO or HMO-POS. These plans allow you to go out of the network electively, usually for a higher out of pocket cost. This can be a tricky situation to maneuver but knowing some of the avenues you can take can make sorting it out a bit easier.
Insurance Company Specific problems
There are countless things that may come up when dealing with health insurance. One of the best pieces of advice we can give is to use the phone number on the back of your cards for issues that may arise. These are customer service lines that deal with the issues you may be having on a daily basis. A phone call to them could sort out your issue or at least give you an idea of what direction you need to go to get the issue taken care of.
The Cost of your Medications Went Up
This is a fairly common issue due to the nature of the prescription drug market. Like the stock market, prescription drug prices can fluctuate daily based on a supply and demand. You may be used to paying a certain amount and then one day have to pay more than normal. Unfortunately, in these cases there isn’t a whole lot you can do. One thing to keep in mind if you have a few expensive medications is that you may be falling into the donut hole and or catastrophic coverage. If this is not the case then most likely your drug plan or pharmacy paid a higher price for your medication, resulting in you paying more.
One place to check would be www.goodrx.com. This is a prescription drug coupon site where you can search for specific medications and find coupons to use in lieu of your insurance. In some cases, these coupons may be more cost effective than using your insurance.
Another possibility is that your medication was classified under a new tier on your drug plan or dropped altogether. This usually won’t happen mid-year, but it has before. If this is the case, you’ll want to call your Part D plan carrier and appeal for a tier exception. If approved it will adjust your medication down to a lower tier, lowering the amount you must pay.
Dosage and delivery method can also affect the price of your drugs so working with your doctor to find a similar medication or dose that is lower cost may be another good option. Fluctuating drug prices is unfortunately a tough issue that doesn’t have a clear-cut answer, but these are some possible avenues you can take.
The best way to avoid this scenario is to review your drug plan each year during the Annual Enrollment Period to make sure all of your medications will still be covered for the following year. As mentioned changes mid-year are rare, but can happen. Staying up to date on the information is your best protection against these issues.
If you’re having trouble resolving anything described here or any other Medicare related issues you can also call the agent who signed you up for the plans for help. Assistance in resolving these issues is a service we offer for our clients here at Doctor’s Choice, so if you’re getting ready to retire or enroll in Medicare, get in touch with us and we’d be happy to see if we can help. As always, thanks for reading!
About Doctor’s Choice:
Doctor’s Choice is the premier service advocate for Medicare, making healthcare transitions easy for employers and their employees. Founded by a Brown University-trained Physician, they deliver best-in-class service to seniors before, during and after their transition to Medicare. Offering coverage across the country and tech-enabled personalized guidance through their Turbo Medicare Roadmap, Doctor’s Choice provides concierge-level service and healthcare advocacy to our members for life. For more insights on retirement trends and employer strategies for an aging workforce, follow Doctor’s Choice on LinkedIn @DoctorsChoice, Twitter @DoctorsChoiceU, and Facebook @DoctorsChoiceUSA.