Problem with creditable coverage

May 8, 2019

  1. billyb
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    billyb Guru

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    I wrote a 74 year old female a Part D recently. CMS charged her a surcharge for not having prior coverage. The problem is that she has always had employer coverage until retiring, but now CMS wants to know every carrier she had coverage with since she turned 65 in 2008. She worked with a group of doctors who were bought out by Sacred Heart. They can't tell her what she needs to know. There is no telling how many times she has changed carriers in 11 years. Is there any way she can get this info from Medicare?
     
    billyb, May 8, 2019
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  2. XpressInsurance
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    If she went to the same provider (primary care) for all that time she maybe able to get it insurance company info from the providers she has seen.

    What really is sad is that Medicare knows who has coverage & when. They probably are not charging her Part B late enrollment penalty, but want to hit her on Part D if she can't provide it.
     
  3. TwoCents
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    "CMS wants to know" & "any way she can get this info from Medicare" -- uh, what have you been drinking?

    Carriers collected creditable coverage information on behalf of CMS. Is this her VERY first time on a Part D plan? If it is, then the letter sent to her asking for the info, should have had a form where she would provide her history -- no actual proof needed. She just attests to having creditable coverage.

    Now, you could also be talking about the Part B LEP and that's another animal and CMS would collect that info and want some proof/something from employer. Good luck with that.
     
  4. LostDollar
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    Are you talking CMS wanting info for Part B Social Security app (form L564)?
    or
    The PDP plan carrier wanting a form completed in order for her to avoid Part D penalty?

    When I created a MyMedicare account and then went exploring in it, I found a tab that said something like Primary Insurance Coverage. It showed the 4 different group plan coverages I had had between turning 65 and applying for Social Security. If all she needs is Part D information, perhaps that info would show in a MyMedicare account for her.
     
  5. Midlevel
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    Fill out the form from the Part D insurer and write she has had credible coverage from the date she turned 65 (or before if you want) and put that it ended the day before she went on Medicare Part B and have her sign it and send it back.
     
  6. billyb
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    We completed a LEP Reconsideration Request Form and listed her current carrier . Now they want names of all companies since her turning age 65. She didn't remember all of the different carriers she had since 2008 and now we have to get that info somehow.
     
    billyb, May 9, 2019
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  7. Midlevel
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    I wonder what she did wrong on the initial form from the Insurance Company to make them deny it and have to do a reconsideration form? I haven't had to do one of them unless they forgot to send the form back to Insurance Company or something.
     
  8. billyb
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    I am not sure what the insurance company has sent her. All I saw was the LEP form. She may have received other request for info and did not return it. Her effective date was October 2018 and she just called me about it in the past few weeks.
     
    billyb, May 9, 2019
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  9. LostDollar
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    The pdp carriers have to see that there are no creditable coverage gaps in excess of 63 days. I think there have been at least two threads about this in the last few months.
     
  10. vic120
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    Sounds like she has been sitting on this and has probably already started paying LEP

    She should have got those forms within 30 or so days from enrollment to PDP, Part B She should have been notified fairly quickly as well Month or 2 at most I would think
     
    vic120, May 9, 2019
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