How to Get a Carrier to Refund a Med Supp Premium to an MAPD Member

Jul 2, 2015

  1. WCMason
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    WCMason Guru

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    So a guy calls me regarding his mother's increasing Medicare supplement premium. She's a retired teacher and years ago took a Medicare supplement out with United Teacher Association. After asking him a few questions found out that a couple of years ago she got enrolled--has no idea how--in a Teachers Retirement System Medicare Advantage plan (this is in Texas). So I explain to him that she can't have--and doesn't want--a med supp and MA plan and should contact the med supp company about a refund of premiums back to the date of the switch.

    UTA confirms they have paid no claims since the MA enrollment despite her having lots of health problems. At first they told the son that their policy was to refund only one year. He appealed that to a supervisor and is now being told no refund is due because they were at risk during that time, a ridiculous claim.

    I had a similar situation to this happen a few years ago with New Era and they immediately refunded 3+ years in premiums (nearly $5,000) as soon as they got proof of the MA enrollment. UTA appears not to be so cooperative. Any suggest possible options for this son to get his mother some money back?
     
    WCMason, Jul 2, 2015
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  2. somarco
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    somarco That Medicare Guy

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    I suspect this is carrier specific.

    New Era had no problem refunding 17 months premium on a Medigap plan I wrote when the guy decided a few months later to pick up a $0 plan. Of course they had not paid any claims during that period because the MA was primary, not Medicare.

    I don't know if the DOI will be any help or not. There may or may not be anything in the policy about premium refunds.

    Most health insurance carriers (non-Medigap) limit refunds to 12 months but if pressed I have seen situations where they exceeded that limit.

    Of course the obvious question is, didn't she notice premiums coming out of her account over the last 3 years?

    You can certainly appeal it up the food chain at UTA. I don't know if anyone at CMS will have an interest in this or not but there might be a pesky news reporter that is interested in a story about a retired school teacher that is being robbed by a big bad insurance carrier.
     
    somarco, Jul 2, 2015
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