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The Medicare Bermuda Triangle

Updated on January 18, 2014

But, I didn't know officer!

We were so ready for retirement. Sleep in, eat when we want, watch a little tv, go to the hairdresser in the middle of the day and just not worry about anything for at least a little while. My wife had just retired two days ago. Then, the problem arrived.

We both received letters from Medicare telling us that we were being charged a penalty for "failing to provide evidence of prior prescription drug coverage that was creditable". Creditable prescription drug coverage is coverage that meets Medicare's minimum standards.

The penalty would be deducted from both of our Social Security checks beginning this month and continuing the rest of our lives! It amounted to almost $50 monthly which is a lot of money to people living mostly on Social Security.

Medicare went on to say that it involved a period from January 1, 2007 until January 1, 2014.

Here is the thing....my wife worked for one of the largest companies in the world and had been in that business for over 40 years. Guess what? She worked for an insurance company which provided us with the best prescription coverage money can buy.

Medicare gave us an opportunity to deny their findings by finding the proof, or evidence of creditable prescription coverage for those seven years, filling out their forms titled, "Reconsideration Request Form" and sending all items to an office in New York called, Maximus Federal Services for their review board to consider.

Here we are in the greatest country in the world and we have been told we are guilty until proven innocent. Notice anything backwards here?

Okay, that in itself was enough to make my blood boil, but as they say, "You ain't seen nothing, yet!"

Just imagine this. My wife's company had been bought out just 18 months ago. They were also bought out one year prior. So, including her first 19 years with this same office, she was employed by three different companies in her 21 years at this same facility.

Think about trying to find evidence of coverage from a company that has no idea what the previous ownership did in that area.

But, first things first. I wanted to know where this ludicrous charge came from. I called Medicare and went through all the voice mail steps which eventually take you to a department that you asked for. But, when you tell them you want to find out about failure to provide creditable prescription coverage, they send you to another department. After making the rounds and telling your story over and over, finally a really nice lady answers my question by telling me that "Somebody made a typo along the way that led to this penalty. I asked her where that somebody was and she simply said that it would have been someone with Medicare. She told me that it happens all the time.

Are you hearing this? It happens all the time and seniors everywhere are having to deal with proving their innocence for a mishap that they did not cause. There are probably thousands of seniors that do not have the know how, or fortitude to fight the system and are being penalized every month for the rest of their lives. Social Security is quietly taking back money that you worked for all your life. Before this one lady gave me an answer, all other Medicare employees said they had no idea where the erroneous accusation came from.

So, the work began. I first called my wife's previous office and asked for the names of the insurance carriers for the past seven years. They provided me with the carriers back to 2008, but could not come up with the carrier in 2007. I called the home office of the new ownership. They could only give me information on coverage since they took over 18 months earlier.

I called our most recent insurance carrier. We no longer were members and I could not get away from the voice mail that continued to ask me for information that I could not provide. I would make up something and it would take me to another voice mail which would ask for more information that I could not answer.

After literally 20-30 minutes, not including a wait time for the next customer service representative, the voice mail started the connection to a customer representative. Would you believe that I got a busy signal?

Of course, now I am going off on the insurance carrier, but it is a result of Medicare's mistake.

I remembered the name of the carrier prior to that and began the same dialing and waiting and answering questions with phony answers in order to get somebody live. When I would finally get to a person, I had no idea of what my wife's company was called at any particular time because of the numerous ownership changes and her office's name change. I would tell my story for the 30th time and get nowhere.

I had a brainstorm! What if I call the pharmacy where we get our medicine and get the names of the drug suppliers that supplied our prescriptions through the various insurance companies? They sent me a list. Now, I had something to work with.

I called the first drug company and received dates of coverage from them. I called the previous drug supplier and they took me all the way back to 2008. That left the final drug supplier for the year 2007.

Now, all I had to do was fax all the information to the review board and wait. I went to my local grocer and they faxed for me with a cost of $23. More money out of our pockets because of the Medicare mishap.

What is your opinion of this error by Medicare and its effect on the individual?

See results

In a nutshell

I literally spent 8 hours a day for 5 days talking on the phone, or should I say, waiting on the phone to defend myself from this injustice. Please do not let this happen to you.

If you are 65 and still working and under a company group insurance plan, prepare yourself for retirement by asking questions when you start enrollment with Medicare Part B. Tell them that you want to know about this creditable prescription coverage and that you want to make sure that they have the information right now.

Have papers with you showing your prescription suppliers all the way back to January 1, 2007.That is when the new rule came into effect. I have done a lot of leg work and it was very time consuming and frustrating, but the good thing to come from all of this is that just maybe I can help the next generation of citizens that are uninformed and prevent them from experiencing the difficulties that I had.

TO SUMMARIZE

When you turn 65, whether you take prescriptions, or not, whether you remain in a group plan at work, or not, carry a prescription plan to prevent penalties down the road. If you refuse part B at age 65 because you are continuing to work, be sure to give them your prescription carrier information.

I have not heard from the review board, yet. Will update this article when I do. That may lead to an entirely new article.

Good luck!

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    • profile image

      Bill Wilson 3 years ago

      More government BS, bummer.

    • discovery2020 profile image
      Author

      WILLIAM EVANS 3 years ago from TEXAS

      Our friends in Colorado were warned by their insurance agent when they turned 65 to take out a policy for prescription drugs even though they did not take any prescriptions at that time. He said it would prevent penalties down the road. Good for that agent!

    • RTalloni profile image

      RTalloni 3 years ago from the short journey

      Sharing experiences like this is important. Thanks for putting this together so others can have a heads up.

    • discovery2020 profile image
      Author

      WILLIAM EVANS 3 years ago from TEXAS

      Hopefully, it pays off for others.

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