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November 11, 2011 > HealthCare... Who Cares?

HealthCare... Who Cares?

Submitted By J. Dennis Wolfe

Retirement is supposed to signal the start of a relaxed life - all sunshine and no schedules. Unfortunately, navigating government retirement benefits, including Social Security and Medicare, can quickly turn into a series of daunting, frustrating tasks.

Last year I wrote a policy called Medicare Advantage for a client who just turned 65. In order to be eligible for a Medicare Advantage policy, he had to be enrolled in Medicare Parts A and B.

For those of you unfamiliar with Medicare, Part A pays a significant portion of in-hospital expenses. The government provides this coverage at no charge to the person enrolling. Part B provides coverage for 80% of eligible and allowable charges for all doctor services, such as doctor visits, lab work, and therapy. Part B premiums are automatically deducted from your Social Security check, if you receive one.

All citizens are eligible for Medicare at the age of 65; however, many individuals are not eligible for Social Security for another year or two. Because of the gap between the two eligibilities, how do you pay for Part B of Medicare when there is no Social Security check from which it can be deducted?

The answer: write a quarterly check to the government; they bill you.

My client, eligible for Medicare but not Social Security, did so. This worked well, until a check was cashed and he was simultaneously informed that it was never received. Medicare proceeded to terminate Part B coverage for non-payment of Part B premiums.

Once it was reported that Part B coverage was terminated, the insurance carrier was notified by Medicare and immediately removed him from Medicare Advantage full and catastrophic cost protection coverage.

As a result, my client went from comprehensive cost protection to having only Part A's limited in-hospital benefits. He presently has no upper limit cost protection for hospital expenses, no coverage for any expenses incurred when not in a hospital, and most importantly, no prescription drug coverage.

This is not an isolated case. When I called the carrier to explain, they already knew about the internal problem with the Social Security Administration (SSA). Local SSA Offices run on one computer database system, and their premium collection department records on another. Moreover, there is no means of contacting the SSA premium collection department.

Even with proof of payment (cancelled checks), the problem persists. While my client has received a letter from the local Social Security Office stating that his wife's coverage has been reinstated, his issue remains unresolved. Until the carrier re-enrolls both husband and wife into their full medical coverage, they only have Part A.

I understand that many think a single payor system is what is needed. Supplemental insurance policies, however, are already 100% dependent upon the government's most visible single payor system: Medicare. When communication within the system fails, you can lose coverage, and no one is held accountable.

Stay healthy. Stay tuned. Get involved. Learn what is being done to you under the cover of daylight. Your life now does indeed depend upon it.

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