Listen and Help Please

[alphawave2k]

So here I am a somewhat experienced Medicare agent/whatever you want to call me and this is my personal dilemma. Wife retired from GA School system and got on Medicare and SHBP MAPD..(which is not what I wanted, but she insisted). I turned 65 Jan '18 and never apparently "officially" signed up according to SHBP folks, though the whole family has been on their health plans. They also claim I/we received notifications along the way to sign up, but perhaps in the sea of mail and notifications we may have inadvertently thrown it out....baby with the bathwater scenario potentially, so shame on me.
So if everything had run according to plan, our premiums for this great plan outside of our Part B, are ~$30/mo for the 2 of us..great, right? So, because I missed signing up before my birthday month which I honestly thought they'd migrate me automatically, the SHBP folks are saying I owe $1800 for one month penalty, and if we don't pay it, they will cancel our plan. I think this is so wrong in so many ways, I can't begin to say.....luckily we're both within our OEP for Med Supp, etc, so that is our 2nd option for now.
Any thoughts on why and how they can exact that type of penalty/ I've called and have the issue "escalated", but it seems the wheels of competence and customer satisfaction grind slowly. I am so incensed I can scream out loud, and did several times.
Any ideas, thoughts and how to get this corrected and rescinded by the most civil approach possible, before resorting to my lower income socioeconomic background tactics, are greatly appreciated. Either way, thank you for your ideas, and for letting me vent.....

 

[TwoCents]

So prior to starting YOUR Medicare, you already had coverage under SHBP (family coverage for non-Medicare beneficiaries due to wife's employment history)? Not every plan is allowed to migrate you into Medicare coverage so that's why that didn't happen. The penalty does seem extremely excessive. Not sure where they're coming up with that. I think you're going to have to take this up with the state dept of insurance.

 

[somarco]

Sounds like you got caught up in seamless conversion.

The rest of your post seems a bit jumbled. Did you and/or your wife, enroll in Medicare A & B before your 65th birthday? Sounds like wife did sign up for A & B plus informed SHBP she wanted their plan.

If you signed up for A & B but did not inform SHBP they are continuing you on the regular group plan as a "regular dependent".

If you and/or your Covered Dependent(s) are age 65 or older at the time of your retirement, you MUST provide information to SHBP for you and/or your Covered Dependent confirming enrollment in Medicare Part B a minimum of 30 days prior to the effective date of your retirement date (ex: If the Active Member’s effective date of retirement is January 1, 2018, and the Active Member and/or Covered Dependent is age 65 or older – Active Member MUST provide information to SHBP confirming enrollment in Medicare Part B for him/herself or Covered Dependent(s) age 65 or older by December 1, 2017. Then, Active Member and/or Covered Dependent(s) age 65 or older would be eligible for enrollment in a Medicare Advantage Plan Option at the effective date of retirement – January 1, 2018).

Understanding Your Eligibility & Enrollment Requirements for Medicare Advantage | State Health Benefit Plan

The school system does not contribute toward the cost of post-65 premiums so it appears they are billing you for the full FAMILY amount and treating your coverage as if you do not have Medicare.

Trying to unwind will be a challenge as you have already discovered. Normally, if you enroll in Part D before the end of December that would disenroll you from a traditional MA plan.

Unfortunately, SHBP is not a traditional plan.

If enrolling in a drug plan does stop the SHBP coverage as of 3/1/18 you still have the issue of owing for Jan & Feb SHBP premiums.

I can tell you that dealing with the folks at BX, SHBP and your local school system is a zoo. Three different entities that can pass the blame along to another.

I was covered under my wife's SHBP until Dec 31 following my 65th birthday in September. Because I knew the problems that come with trying to leave the plan at the end of the year I decided to enroll in A & B while keeping the SHBP in place as primary. During that years OE my wife notified SHBP, the school system, BX and (I think) Houze that I would not be on her plan as of 1/1/16.

In spite of all that the folks at BX continued to show me as a dependent (wife was an active employee, not retiree) until March or April. They did not deduct 2016 dependent premiums but never notified Medicare they were no longer the primary payer.

There were a few small claims during that time of "double coverage" and it was June or July before it finally got settled.

What will BX do if you do not pay the premiums?

They can't come back against your wife's employer.

At the very least you need to find out if enrolling in a drug plan will disenroll you from SHBP. Beyond that, if it were me, I would dare them to come after me for the 2018 premiums.

You may feel differently.

 

[kgmom219]

Ugh. I'm sorry.

1. Remember that SHBP is a government plan and they get to make their own rules up as they go
2. I would do multiple things at the same time: enroll in a Med Supp with the last possible date of open enrollment in GA. Same for Part D. At the same time, file a grievance with EVERYONE. SHBP. The Georgia DOI. And your state legislative rep. And whoever the head of the committee is that oversees SHBP.
3. One question I wasn't clear on: can your wife stay on the plan for $15/month? Or is it all or nothing? Pay the $1800 or you are both terminated?

 

[alphawave2k]

The rest of your post seems a bit jumbled. Did you and/or your wife, enroll in Medicare A & B before your 65th birthday? Sounds like wife did sign up for A & B plus informed SHBP she wanted their plan.

If you signed up for A & B but did not inform SHBP they are continuing you on the regular group plan as a "regular dependent".

Yes, that is the case. Sorry for not being more clear. She has been on the SHBP UHC MAPD since September (Part A & B) effective dates, so no problems with her. I was the one that effed up apparently. I did sign up for Medicare Part A & B effective Jan 1 '18, but didn't notify the plan and as far as I know I don't recall getting any reminders, particularly if there was going to be a penalty for not signing up.

What will BX do if you do not pay the premiums?

They are threatening to cancel the plan, I guess entirely. It's not BX, it's UHC and it's not them either it's a third party "Wage Works, Inc" an intermediary of SHBP that sent the notification, saying we must pay the "Dependent UHC High Deductible Health Plan to the tune of $3700+ by grace period end of March. This is presumably a penalty for 2 months of not having signed up, January and February. Since we called after getting the letter, now they said it would just be January. I think this "penalty" is excessive and bogus.

3. One question I wasn't clear on: can your wife stay on the plan for $15/month? Or is it all or nothing? Pay the $1800 or you are both terminated?

I am not totally clear on this. It seems the entire plan would terminate...so that would kick both of us and our under 26 offspring off.
KG, you confirmed what I had been thinking and planning to do. I started a grievance verbally through their grievance channel, but if I don't get this rescinded, I do intend to file a grievance with everyone involved, though the offending party seems to be the SHBP. I think this is ludicrous, bordering on extortion. The average person getting caught in this mess would probably cave and pay this "penalty". I can see something more reasonable, double or triple the premium, though no claims have been filed by me, and probably would pay it, but on moral ethics and personal principle I intend to fight this. If I lose, they can keep their plan and I'll go to option 2. Med supp+PDP for us both. The only thing is not sure what to do with our daughter, since she is currently not working and probably won't clear $12K for the year....
Thank you both for input!

 

[kgmom219]

YThe only thing is not sure what to do with our daughter, since she is currently not working and probably won't clear $12K for the year....
Thank you both for input!

Your daughter needs to write some thank you cards and get a 1099 from daddy

 

[somarco]

I don't recall getting any reminders,

If you haven't thrown it out, it comes in the form of an "opt out" agreement. If you don't opt out they assume you are opting in.

Isn't that a kick in the pants?

They are threatening to cancel the plan, I guess entirely.

I don't see how they can cancel your wife since she has retiree coverage. If they do, you said she was in her 6 month IEP, write her a Medigap.

It's not BX, it's UHC and it's not them either it's a third party "Wage Works, Inc" an intermediary of SHBP that sent the notification, saying we must pay the "Dependent UHC High Deductible Health Plan to the tune of $3700+ by grace period end of March.

Wage Works is administering the HRA/HSA portion. UHC handles the claims. The SHBP is a self funded plan which means the DOI has no jurisdiction.

The Dept of Community Health is another entity that has their fingers in the pie. So you have them, the state, your local school district, Wage Works and UHC.

As you have outlined the situation, it is basically your fault. I don't see how you can cast blame on any of them. My advice is, if they are willing to let you off with just paying the Jan premium do it and move forward. Then run, don't walk, and get you and your daughter covered before you both end up with nothing for 2018

I think this "penalty" is excessive and bogus.

It's not a penalty per se, just the regular family premium. And yes, they are being a "richard" about this.

Tell them you never got the form to opt in or out. They can't prove you got it.

The only thing is not sure what to do with our daughter, since she is currently not working and probably won't clear $12K for the year....

Ah, another shoe drops.

How old is your daughter?

If she was covered under the plan for 2017 then she should have been dropped as well and put on an Obamacare plan. This would have been handled during the open enrollment which occurred in (I beleive this is correct) November. Seems like it was a short window, something like 2 weeks as I recall.

Your wife should have received the OE material in Oct or early November.

If they cancel, they are just cancelling you and daughter. Not your wife. She is under a separate plan. And that further confirms my suspicion they are billing $1800/mo for family coverage (you + daughter).

 

[baxwink]

I would be very interested in talking with you. I am in a dilema as a result of losing state health coverage (I'm a State Educator Retiree) because SHBP of Georgia says I received a letter from them, Wageworks, ADP or some one that I should have responded to within a certain period of time. I never received a letter and SHBP admitted that it was not not mailed certified. I have had issues in the past with my mail service and even have a letter from the postmaster to back it up. I have gone through the entire appeals process and the final "no reinstatement" came from SHBP 112 days after my appeal was filed. Now I find that I have waited too long to even get into any type insurance until next enrollment period for my family or myself. I too got a $2500.00 penaltty when I turned 65 for not notifying ADP that I would be turning 65. I paid and everything has been ok until now. I would like to organize enough folks to appeal to the legislature and get ADP/Wageworks out of the picture so that common sense can once again prevail at SHBP. I would love to have your contact info. I'm [email protected]