Group Retiree Part D - Not Creditable Coverage

[Northeast Agent]

A friend's widowed mother receives med supp, drug, dental and vision benefits through her deceased husband's union benefits.

She recently received a letter stating the drug coverage isn't creditable. Until a year or so ago, she had an inexpensive, standalone Part D plan but she dropped it as she didn't think she needed it. I had her call Social Security and she was told she'll have a LEP of $4.50-$5.00 per month if she picks up a Part D again. I told her it might be a good idea to do so, because from the sound of this letter, there's an annual maximum of $625.00 per individual?

She can, apparently add a Part D and keep her current drug coverage, which will pay secondary to Medicare. I'm confused though - should she use the current coverage for whatever it covers and Part D for whatever it doesn't?

This drug coverage not being "creditable" seems like someone could get big-time screwed over if they got divorced when they are elderly and had no clue about the LEP.

Normally I don't do Part D for someone, unless I get their Med Supp as well, as it's a hassle, but this is a favor for a friend.

 

[StephanieCJ]

Don’t see where you asked a question, but if it is should she get a drug plan, I would say yes. When I have clients who are on no medication, I usually just go with the least expensive one in the area. I also have a couple of clients with VA coverage who wanted a drug plan just in case when they travel and are away from the VA. They also get the lowest cost plan typically.

 

[Northeast Agent]

My question is, if she gets a standalone Part D then Medicare becomes the primary payer. So I'm trying to figure out what should be run through the retiree plan and what, if anything through the Part D.

 

[somarco]

I don't recall ever seeing a secondary PDP policy. Most of what is out there are discount plans like GoodRx. You can use Part D, or GoodRx, but not both.

A bit confused about where you found the union plan pays secondary to Part D. Was that in a letter from the union, or something in the benefit book? Paying secondary implies COB and a 2nd claim filed after the PDP pays. A paper claim?

Is there a premium for this secondary plan? Does it really have value?

 

[TwoCents]

I just want to point out that the heading "Group Retiree Part D - Not Creditable Coverage" makes no sense. If it were Part D then it would be creditable. So maybe next time just call it a drug plan.

Somarco asks good questions. If she's not paying for the group plan, then figure out COB. Hopefully, it won't be a hassle for whatever pharmacy she would use to file the claims.

 

[LostDollar]

My Kroger pharmacy will not file any secondary claims. Period.

edit
coordination of benefits, page 14
https://www.cms.gov/Medicare/Prescr...r-14-Coordination-of-Benefits-v09-14-2018.pdf
end edit

 

[Northeast Agent]

Somarco, in the fourth paragraph of the attached file it says "you can keep your current medical and prescription drug coverage with (former company name) Combined Health & Welfare Retiree Plan and enroll in a Medicare Prescription Drug Plan. If you do this, (former company name) Combined Health & Welfare Retiree Plan will pay secondary to Medicare."

She pays so much per month for the combined supp, drug coverage, dental & vision package.

 

[somarco]

OK, I rarely click links and/or download files on the forum.

Still does not seem to address my questions.

"So much per month" is not helpful

 

[Northeast Agent]

She said the monthly premium for the whole package is taken out of her deceased husband's pension, so she never sees it. Has no clue of the cost.

 

[somarco]

The longer she goes without creditable coverage the higher the penalty. If this union drug plan has a max benefit of $625 seems a no brainer to jump back on the PDP wagon