Medicare "Collision" ?

[brooks]

Learned a new term from our local hospital ... "Medicare Collision." It's when you have both a Medicare supplement plan and an MAPD.

Caller had retired. He had retiree benefits. Retiree benefits were a full blown MAPD through United Healthcare. He kept this plan. Liked the prescription drug coverage as well as coverage for dental, vision and hearing.

Caller had also bought a Medicare supplement plan. Carrier had told him he could have BOTH his retirement plan and a Medicare supplement.

This came up as caller was going to have elective surgery. He was going through the process of pre-determining costs. He thought he had the choice of MAPD or Medicare. He wanted to use his Medicare supplement as it would be cheaper.

Medicare kicked it back. "NO CAN DO" ... says Medicare. Medicare won't pay as Medicare says medical bill will be responsibility of his Medicare Advantage plan.

Caller called me. How can this be? Somehow, his 800-Med-icare representative is not available.

 

[WCMason]

Learned a new term from our local hospital ... "Medicare Collision." It's when you have both a Medicare supplement plan and an MAPD. Caller had retired. He had retiree benefits. Retiree benefits were a full blown MAPD through United Healthcare. He kept this plan. Liked the prescription drug coverage as well as coverage for dental, vision and hearing. Caller had also bought a Medicare supplement plan. Carrier had told him he could have BOTH his retirement plan and a Medicare supplement. This came up as caller was going to have elective surgery. He was going through the process of pre-determining costs. He thought he had the choice of MAPD or Medicare. He wanted to use his Medicare supplement as it would be cheaper. Medicare kicked it back. "NO CAN DO" ... says Medicare. Medicare won't pay as Medicare says medical bill will be responsibility of his Medicare Advantage plan. Caller called me. How can this be? Somehow, his 800-Med-icare representative is not available.

There is a reason it's illegal to sell a med supp to an MA member if the latter isn't being replaced: the med supp is worthless. It covers nothing. Zip. Nada. Zilch. They don't coordinate; they collide.

 

[goillini52]

There is a reason it's illegal to sell a med supp to an MA member if the latter isn't being replaced: the med supp is worthless. It covers nothing. Zip. Nada. Zilch. They don't coordinate; they collide.

Yep, they can't have a Med Supp if they don't have Traditional Medicare.

 

[rousemark]

Learned a new term from our local hospital ... "Medicare Collision." It's when you have both a Medicare supplement plan and an MAPD.

Caller had retired. He had retiree benefits. Retiree benefits were a full blown MAPD through United Healthcare. He kept this plan. Liked the prescription drug coverage as well as coverage for dental, vision and hearing.

Caller had also bought a Medicare supplement plan. Carrier had told him he could have BOTH his retirement plan and a Medicare supplement.

This came up as caller was going to have elective surgery. He was going through the process of pre-determining costs. He thought he had the choice of MAPD or Medicare. He wanted to use his Medicare supplement as it would be cheaper.

Medicare kicked it back. "NO CAN DO" ... says Medicare. Medicare won't pay as Medicare says medical bill will be responsibility of his Medicare Advantage plan.

Caller called me. How can this be? Somehow, his 800-Med-icare representative is not available.

The reason it can be is because he does not have Medicare... He has a medicare "replacement" plan.. The supplement cannot pay because there is nothing to supplement since Medicare has been replaced by MAPD and will not pay anything. Medicare paid the MAPD carrier to take care of the client medical expenses.

 

[somarco]

He is entitled to a full refund of all Medigap premiums. That will help pay his OOP from the hospital stay.

 

[WCMason]

He is entitled to a full refund of all Medigap premiums. That will help pay his OOP from the hospital stay.

That is true. I helped a client get a refund of about $4500 from her med supp carrier awhile back.

 

[TDFnCali]

He is entitled to a full refund of all Medigap premiums. That will help pay his OOP from the hospital stay.

I hope I never run into anything like this, but since this is my career now, Im sure I will at some point.....where do u go to get that refund process started?

 

[somarco]

The Medigap carrier should refund back premiums. Ask them. Hopefully they haven't had more than one Medigap carrier.

 

[WCMason]

I hope I never run into anything like this, but since this is my career now, Im sure I will at some point.....where do u go to get that refund process started?

I helped the client write a letter to the carrier explaining the situation and requesting the refund. She included a copy of her MA ID card. It took a couple of months to get the check. The ID card along with their own records showing no claims submitted to them seem to be all they needed.

 

[sman]

That is true. I helped a client get a refund of about $4500 from her med supp carrier awhile back.

I did the same, but it was only about $2,700. I also contacted the regional director for the Med Supp carrier to let him know this particular agent might need some additional training as the client was very adamant that he told the agent he had a Medicare Advantage plan (showed him his Humana I.D. card). The agent said the Med Supp would pay what the MAPD doesn't pay.

I just I wish I could have seen the agent's face when he got the chargeback.