A reason an enrollment might not be accepted by an insurance plan is mostly for medigap insurance. If you try to enroll without any special enrollment period and have preexisting conditions in most states they can deny you. A reason Medicare might do it is if they think you already have coverage a different way. So, for example, if you tried to enroll in a Medicare Advantage plan that included prescription drug coverage and also a part D insurance plan - Medicare would reject one of those enrollments because you cannot enroll in two part D plans.
You will know you have successfully enrolled in an insurance plan and are setup to get your subsidy from Extend Health if several things happen:
- The insurance plan tells you that you have been enrolled.
- Your profile is updated on Medicare's database . You can call 1-800-Medicare if you want to check your 2014 enrollment because the Medicare website will only show the plan you are using for 2013 - and it only applies to Medicare Advantage and part D insurance. Medigap insurance updates probably won't be accepted until January 2014.
- Your EH website profile shows that your application is completed.
- EH sends you a letter saying you have been successfully enrolled.
I have successfully enrolled. However, my spouse's application is still "open" on the Extend Health website which means EH has not been notified by the insurance company that the policy is accepted. However, my spouse's insurance company sent us a letter on November 8th saying the policy application is accepted. On November 20th I check the EH application status and when I saw it was "open", I emailed Extend Health and they told me it takes a couple of weeks for the insurance company to notify them. I was surprised because the insurance company for my plan was quick to notify Extend Health that my plan was accepted. Well, here it is December 20th and the EH website application status is still "open". I just sent a second email to Extend Health telling them we are concerned about the status. I am doing this to build a case so if they try to deny my spouse's subsidy we have proof we did everything "right" and can complain to IBM so that we can get the subsidy.
I am also doing this so that if something really messes up I can file a grievance with Medicare that Extend Health is not acting as a proper insurance agent on my behalf.
Now that we are in the individual Medicare insurance marketplace, it is extremely important to keep a record of every conversation you have with Extend Health (who is your insurance agent), your insurance provider, Medicare agents, Social Security agents and any other government agency agent you contact. You must get names of the people you talk to and what you heard - down to time of day you heard it. That is the evidence you will need if you have to do an appeal with Medicare for either inappropriate marketing (EH), claims denials (insurance companies), misleading information that caused you to make poor insurance choices (government agencies and/or EH) or grievances such as for poor customer service (EH and/or your insurance provider).
12/26/13 Update: EH responded to my email by calling to tell me they had received notification from my spouse's part D plan so the application process is complete. How coincidental that they got notification shortly after receiving my email. Amazing ... isn't it? I looked on the EH website to be sure it had been updated and it was. Finally, we are both set up to get our HRA subsidies. It only took 2 months of work to do it! I should send a bill to IBM for project management services.
I received my Summary Plan Description USHR 112 Effective: January 1, 2014. I have noted specific sections of the document that are specifically addressed to Medicare Eligible Retirees.
ReplyDeleteOn pages 165-166 it discusses Coverage for Medicare-Eligible Retirees.
On pages 167-176 it discusses the Health Reimbursement Arrangement (HRA).
Your questions can be addressed by calling the IBM Employee Services Center at 1-800-796-9876.
Roger
I am going to cross-post this letter I received from the IBM Benefits group on to 2 other msg groups. I hope this clarifies this issue. I will also submit this letter to the IBM Support group at EH so that they can train their reps accordingly.
ReplyDeleteRoger
Dear Mr. Meggyesy,
This is in response to your email to Barbara Brickmeier regarding reimbursement for your Medicare Part B premium. I apologize for the delay in my response.
The Medicare Part B premium you pay is an expense eligible for reimbursement from your Health Reimbursement Arrangement (HRA). As you know, Medicare Part B premiums are also reimbursable expenses under the IBM Special Health Assistance Provision (SHAP). If you choose to be reimbursed for your Medicare Part B premium through your HRA, if there is any excess premium amount remaining that is not reimbursed from your HRA, you can submit the remaining amount under the SHAP. The question you reference on the claim form asks "Are you receiving coverage for Medicare Part B premiums from any other source?" If so, you must provide the amount. For the HRA, you would select "Other" as the source. This question is specific to Medicare Part B premiums, and not for medical expenses which are not considered premiums.
The intent of the SHAP is to provide eligible retirees with assistance towards the premiums they pay for Medicare Part B coverage. You are not eligible to submit your Medicare Part B premium expense to the SHAP for the purpose of being reimbursed twice for the same expense for which you claim reimbursement from your HRA. In addition, please note that before submitting an expense for reimbursement from the HRA, you are required to certify on the HRA claim form that the expense has not been reimbursed from any other source, and will not be submitted for future reimbursement.
If you wish to use the SHAP for reimbursement of your Medicare Part B premiums, you must submit your premium expense to SHAP first, then you can claim the amount of unreimbursed Medicare Part B premium from your HRA.
With respect to your concern regarding use of the word "coverage" related to Medicare Part B premiums on the SHAP claim form, based on your input, we will consider clarifying this language on the claim form.
I trust this answers your question. Thank you for writing.
Kyu Rhee, MD, MPP
Vice President Integrated Health Services
Unless I am missing something, you would always want to submit your medicare B premium to SHAP first to get the 80% up to the $900 max,and then submit to your EH HRA to get reimbursed for the rest.Why would yo want to do it in reverse,and use more money from your HRA?You have until June of each year to file for reimbursement from your HRA for expenses from the previous year.After talking with EH,I will continue to file quarterly with Acclaris using my SHAP,and then,after receiving my 4th quarter reimbursement in January of the next year, print a copy of the $900 reimbursements from the Acclaris website to include with the claim to EH for the balance of my Medicare B premium from my HRA,if there is enough money left in it.I always can get $900 from my SHAP,so want to leave as much money in my HRA as possible to use for other expenses.
ReplyDeleteI totally agree with your analysis. It is the only way to get 100% of SHAP money. I think people got confused and thought the SHAP money was also being put into their HRA. It is no wonder - it couldn't be more confusing.
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