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$30,000 Pharmacy Claim Reduced to $0

August 7, 2015

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Health Insurance Marketplace Loophole Corrected

August 7, 2015

 

George’s company cancelled their insurance when the Affordable Care Act (ACA) went into effect because it would have cost their employee’s $1200/month for insurance. The company believed it would be better for each individual to find their own insurance in the Marketplace. George was on his employer’s plan, but he now had to find other insurance. He had just turned 65, so he was looking into signing up for Medicare. He was having difficulty with this so he called CarePartner.

 

Because this was August and enrollment wasn’t until October, he needed the special enrollment form and had difficulty obtaining it. We connected with Medicare and the company HR to get this corrected so insurance could start September 1, instead of waiting until October/November. Unfortunately, there were issues with the break in coverage. We called multiple people and places to get it clarified as to why George would not get Medicare to start September 1 and had to wait until November 1. It turned out there was a loophole that would not allow George to receive the coverage under the Special Enrollment Period. He would not have insurance September and October.

 

We were not satisfied with the answer and we continued to work on behalf of George by contacting the Insurance Broker from his current employer, Medicare officials, Social Security Administration, Mississippi Department of Insurance and the governor to see if there could be an exception made in the law to allow him those two months of coverage. Although were were told it’s the law and can only be changed by legislation, we were able to get his employer to make an exception with the insurance to obtain two months worth of coverage.

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