At this time of year, people enrolled in a Medicare Advantage plan cannot change their plan, or dis-enroll from their plan – unless they meet certain requirements such as: they are moving to a new state; they qualify for a chronic illness plan; they get help with their prescription costs through the Low Income Subsidy (LIS). These people get a “special election period” to enroll in a new Medicare Advantage plan at this time of year.
So how did a client of mine get changed from one Medicare Advantage plan to another when she did not qualify for a “special election period”? The answer is that her husband made a mistake by using an on-line application for a product he did not understand.
Bill was trying to help his wife, who is disabled and under 65. She has been enrolled in a Medicare Advantage plan since she got her Medicare last summer. But because Medicare Advantage plans pay 80% of the cost for durable medical equipment, Bill went on-line to see if he could get some kind of supplement to cover 20% of the cost of the expensive wheelchair his wife will need soon.
Bill is a smart guy, but he made a mistake by filling out an enrollment form on the Humana website. Bill thought he was signing his wife up for some sort of supplement that would fill the gaps in his wife’s Medicare Advantage plan. He put in his wife’s Medicare information and hit the submit button. Then he realized he had made a mistake, so he called Humana and asked them to cancel the application he had just submitted electronically.
The Humana representative told him she would cancel his on-line application, so he thought he was okay. That was near the end of February. Last week, Bill got a $177 bill for the Humana Gold Choice Private-Fee-For-Service (PFFS) Medicare Advantage plan. Uh, oh.
Bill called Humana and they said his wife is enrolled in their Advantage plan. He called Health Net, the plan his wife had been in, and was told she had been dis-enrolled from their plan.
Bill called me and I couldn’t understand how his wife got enrolled in the Humana plan because she is not allowed to change her plan at this time of year. Even though Bill made a mistake by submitting an on-line application, it should have been rejected because his wife does not have a “special election period” (SEP) to change her plan. Humana should have realized this and rejected the application. Additionally, Medicare should have rejected the application.
So what SEP code did Humana use to get this application through Medicare’s enrollment period rules? And why did someone at Humana tell Bill she would cancel the application and then not do it?
Bill and I called Medicare and were told by a representative that there was nothing Medicare could do about the Medicare Advantage plan change because it was done on-line. The Medicare rep said Bill’s wife is stuck in the Humana PFFS plan until next January.
After some discussion, the Medicare rep got a supervisor who gave us a different answer. The supervisor said she would put in a “complaint” to Humana and Health Net and ask them to cancel the Humana enrollment and re-instate the Health Net enrollment for Bill’s wife.
All this happened a week ago, last Friday. On Monday of this week, Health Net called Bill. On Wednesday, Bill got a call from Humana. They said they will try to fix the enrollment mistake. So we’ll wait and see if the Medicare Advantage companies can fix a problem Medicare said it could not fix.
The lesson here is that even smart people like Bill can make mistakes when they fill out important applications on-line. Enrolling in Medicare Part D, or a Medicare Advantage plan is too important to do on-line. Bill did not understand what he read about the Humana Gold Choice PFFS plan, but he figured it couldn’t hurt to put in an application.
Yikes! Bill had no idea about the consequences of that application. He did not realize it would cancel his wife’s Health Net Medicare Advantage plan and replace it with a very expensive Humana PFFS plan that requires higher co-pays than the Health Net plan and the same 20% co-pay for an expensive electric wheelchair.
But how did the application get through to Medicare and get approved by Medicare? It should have been rejected by both Humana and Medicare. Hopefully this all gets fixed, but we’ll have to wait and see.