By Susan Jaffe
JUNE 6, 2019
At
least a quarter of a million Medicare beneficiaries may receive bills for as
many as five months of premiums they thought they already paid.
But
they shouldn’t toss the letter in the garbage. It’s not a scam or a mistake.
Because
of what the Social Security Administration calls “a processing error” that
occurred in January, it did not deduct premiums from some seniors’ Social
Security checks and it didn’t pay the insurance plans, according to the
agency’s “frequently asked questions” page on
its website. The problem applies to private drug policies and Medicare
Advantage plans that provide both medical and drug coverage and substitute for
traditional government-run Medicare.
Some
people will discover they must find the money to pay the plans. Others could
get cancellation notices. Medicare officials say approximately 250,000 people
are affected.
Medicare
and Social Security said they expect proper deductions and payments to insurers
will resume this month or next. Insurers are required to send bills directly to
their members for the unpaid premiums, according to Medicare.
But
neither agency would explain how the error occurred or provide a more exact
number or the names of the plans that were shortchanged. The amount the plans
are owed also wasn’t disclosed. A notice to beneficiaries on
Medicare’s website lacks key details.
Rep.
Richard Neal (D-Mass.), who chairs the House Ways and Means Committee, and two
colleagues wrote to both agencies about
the problem on May 22 but have not received a response from Medicare. Social
Security’s response referred most questions to Medicare officials.
Organizations
that help seniors say they are getting some questions from Medicare beneficiaries.
Two seniors in Louisiana lost drug coverage after their policies were canceled
because of the SSA error, said the state’s Senior Health Insurance Information
Program (SHIIP) director, Vicki Dufrene. One woman had had the same drug plan
since 2013, and it dropped her at the end of April. She was without coverage
for the entire month of May until earlier this week, when Dufrene was able to
get her retroactively re-enrolled.
Dufrene
said some people might not notice that their checks did not include a deduction
for their Medicare Advantage or drug plan premiums. If their check was a little
more than expected, they could have assumed that extra amount was the expected
cost-of-living increase, among other things.
In
Ohio, a Medicare Advantage plan reinstated a member due to unpaid premiums less
than 48 hours after the state’s SHIIP got involved, said director Christina
Reeg.
Medicare
beneficiaries have had the option of paying their premiums through a deduction
from their Social Security checks for more than a decade, she said. However,
they can also charge payments directly to a credit card or checking account
instead of relying on Social Security.
Humana
spokesman Mark Mathis said about 33,000 members were affected — or fewer than
1% of its total Medicare membership. None of those members lost coverage. The
company blamed Medicare’s nearly 15-year-old IT systems for the failure and
urged the agency to invest in new equipment.
A
UnitedHealthcare representative said none of its 32,000 Medicare Advantage or
Part D members affected by the SSA problem lost coverage. The company has the
highest Medicare enrollment in the U.S.
Aetna
has not received payments for Medicare Advantage and drug plans for the months
of February through May for 43,000 affected members, said spokesman Ethan
Slavin. Customers will receive bills for the unpaid premiums and can set up
payment plans if they can’t pay the entire amount.
These
and other affected insurers must allow their members at least two months from
the billing date to pay. And they must offer a payment plan for those who can’t
pay several months of premiums at once, Medicare said. With both steps, “plans
can avoid invoking their policy of disenrollment for failure to pay premiums
while the member is adhering to the payment plan,” Jennifer Shapiro, the acting
director for the Medicare Plan Payment Group, warned the companies in a May 22
memo.
Lindsey
Copeland, federal policy director for the Medicare Rights Center, an advocacy
group, said she is concerned that older adults will view the bill with
suspicion.
“If you
think your premiums are being paid automatically and then your plan tells you
six months later that wasn’t the case, you may be confused,” she said.
Susan
Jaffe: Jaffe.KHN@gmail.com,
@SusanJaffe
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