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I have been married to a wonderful man for 19 years. We were blessed with 2 beautiful daughters who are now teenagers. I homeschool my children and work full time outside of my home. I recently opened my Home Business

Thursday, May 5, 2011

Medicare, Medicaid, Part D Supplemental Insurance and Our Seniors....Update

When I posted this a few weeks ago I promised I would update as soon as I knew something...well, GOOD NEWS! Praise the Lord, my grandmother is being REFUNDED the premiums this insurance company took from her!  I so greatly appreciate your prayers during this time.  God heard you all!

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Good morning. I find myself a pit baffled and some what agitated with the way our senior citizens are being treated. Most of them receive a Social Security check each month and for many, this is the only source of income they have. Their Medicare premiums are deducted each month from their Social Security checks. Our government created the Medicare Part D Supplemental Insurance plans to "help" our seniors afford their medications. If the seniors have both Medicare and Medicaid the receive "extra help" covering the premiums on the Part D Supplement...and NOTHING should be taken from their SS checks to cover this particular insurance; however, many Seniors today are being scammed and stolen from by these insurance companies!

Let me give you an example of the type of "fraud" being used by these type of companies. My grandmother is a prime example. She turned 80 yrs old in January. About 25 years ago she had a stroke which affected her speech and the right side of her body.  She is not comfortable talking on the phone because of how her speech was affected. Any way, in 2006 she signed up with a particular insurance company selling the Medicare Part D coverage. Her pharmacist helped her choose a company which covered the majority of her medications. Because she was covered by both Medicare and Medicaid she qualified for the extra assistance for the premiums of the Part D coverage...meaning in short that nothing would be withheld from her SS income for these premiums. Each year by December 31st you have enroll in a Part D plan, or renew your current plan. If you do nothing, your current plan automatically renews.  This is USUALLY OK; however, sometimes the insurance companies make changes to the plan you are on. They may not cover your prescriptions any more or they may raise the premiums of your plan and start withholding money from your SS income!

This is what has been happening to my grandmother! In December she went into her pharmacy and asked about her Part D Supplement. The pharmacist told her it had been paying well and advised her not to make changes. Unfortunately, what the pharmacist did not know is that the insurance company had rate changes which would adversely affect my grandmother. She followed her pharmacist advice and made no changes to her plan. On January 1st, her insurance automatically renewed WITH THE HIGHER RATES! When her SS check was direct deposited into her checking account it was nearly $50 LESS because of this premium! She had NO knowledge they had raised the premium or that they were going to start withholding money from her check! She did not receive ANYTHING in writing, by phone, or in any form letting her know of these changes! She didn't even know that they had taken the money out of her check. She knew what her SS check was supposed to be, and that is what she wrote in her check register. She did not receive notification from the Social Security Administration that her check would be decreased by the nearly $50 each month either. Towards the end of January she received a notice from the bank that an item had been returned. The bank did pay the item, but they charged her their fee. She searched her check register and bank statement, she couldn't figure out why the item had returned. She was showing that she should have still had money in the bank. February and March were the same. She contacted me. I was verifying each item on her statement with her and when it came to her deposit I stated, "Your direct deposit was $x amount." To which, she replied, "NO, it's not. It's supposed to be $XX amount." I said, "Well, here is your problem."  I went all the way back to January and verified her deposits. Each month it was short nearly $50.

Our next stop was the Social Security Administration. We asked them WHY her checks were short each month. They informed us it was because of her Medicare Part D coverage. We asked how they could withhold funds from her checks WITHOUT her KNOWLEDGE or CONSENT! They didn't have any answers. They gave us the telephone number of the insurance company. They were NO help. She instructed them NOT to withhold any more money from her check. They continued to do so. We contacted Council on Aging. They helped her cancel this coverage and signed her up with a new plan. This insurance company is STILL withholding funds from her check!

We were told that she needed to complete a form to apply for extra assistance. I went online and found the online form and was going to help her complete this application; however, the directions for this form state in bold letters DO NOT COMPLETE THIS APPLICATION IF YOU HAVE BOTH MEDICARE AND MEDICAID BECAUSE YOU ALREADY ARE ELIGIBLE FOR EXTRA ASSISTANCE. So, we called the Department of Social Services [Medicaid office] and spoke with a case worker. She did some research and called us back. She informed us that it wasn't the Part D coverage being withheld, it was life insurance. She gave me another number to call for more answers.

I called this number and the nice lady stated she didn't think it could be life insurance. She placed me on hold and called the Governor's Office. They informed her that the only thing that can withhold from your SS check is Medicare and/or Medicare Part D Supplemental Insurance. She redirected me to Council on Aging. I spoke with another very nice lady here. She informed me that they had cancelled the insurance with the company who was withholding the money and signed her up with a different insurance carrier. This new insurance took affect May 1st. The old insurance withheld the nearly $50 again in May! She stated they would refund this amount for the May payment. I asked her about the possibility of getting the rest of the money refunded as well. She stated they probably would NOT refund this nearly $200. She said the insurance company would state that "she had coverage with them during this time". I explained to her again that grandmother did not receive any notification of premium changes or intent to withhold funds from her Social Security Income. I reminded her also that we didn't even know that they were withholding the money until the end of March and that we have been trying for 2 months to get this STOPPED and her money refunded. The Council on Aging stated they would continue to work on this and advised me to contact our Senator's office.
 I immediately contacted our Senator's office. I explained yet again what has happened. I went as far as to tell his assistant that this was nothing short of stealing! I reminded her that credit card companies, banks, finance companies, and the such have to notify you in writing of policy changes which affect you...the consumer; and told her I felt it should be the same for these Part D Supplemental insurance companies. I told her that in my mind it is a CRIME for them to rip off our Seniors who have worked hard their entire lives to live off of pennies a day and then have them stolen by companies such as this! She agreed. I also reminded her that if she or I had taken money from someone in this fashion, WE WOULD BE IN JAIL!

So, here we...waiting. There is a process in everything that you do. You have to jump through this hoop and that hoop, touch your nose 3 times while rubbing your belly, stand on your head, and flip backwards...and maybe, just maybe in the end you will receive help.

Our Senator's office is mailing me forms to complete and I have to complete a statement of events and the run around we have been on...and hopefully they can help us get her money back. There are no guarantees though. If though don't, do we stop there? NO! If need be, we take a class action lawsuit on behalf of ALL Seniors! This has got to STOP!  

To All Seniors and their families: KNOW YOUR RIGHTS!

  3. You have a right to CANCEL this coverage and receive it from someone else!
Many pharmacies now offer "advice" on these Part D plans. The downside to this is that often they do not know about premium and policy changes. Get a copy of your medication list from your doctor or pharmacy and schedule an appointment with your Council on Age for assistance with renewing or changing your Part D coverage each year. This is for your protection! If you have questions...ASK them! The only dumb question is one not asked. If you do not understand what is being explained to you, let them know that you don't...it's hard for most people to understand these plans!

May this save someone else the headache and heartache my grandmother has been experiencing this year. I will update you once this is settled on the outcome of her ordeal.  God bless you!