This is a snoozer. Let me say that up front. I try in almost all cases to keep these posts fresh and snappy as well as informative. This is pretty much just the latter. If it helps you in some way, that’s extra good. But mostly it’s just to establish a public record and illustrate just how insane bureaucracy gets.
Once upon a time the ACA was passed. Let’s make this clear. I adore the President. I totally get why he pursued the formation of what we fondly call Obamacare. Facing Congress and its known excesses of idiots, he figured that a health care plan that they had originally put forth as the alternative to Bill/Hillary care would garner a fair number of Republican adherents and grease the skids for an easy passage.
We know that that did not happen. What follows is somewhat critical of the Act, but I am very grateful at the same time. I believe health care is the right of all human beings.
That said, here’s what happened to me.
I applied, ran into the usual snafu’s at the beginning and was left with not being “verified”. I waited several weeks and tried again only to find that the validating company no longer had my “ticket” and I could not proceed with my application. By phone I was able to do so and I don’t fault the workers who manned those lines to assist people through the process. Mine came up “may be eligible for Medicaid”. Even though common sense told me I was not eligible, I was forced to go through that process.
I went to a “facilitator” here locally in Las Cruces. She insisted that the Medicaid New Mexico laundry list of financial questions were “inappropriate” and that all that was required was how much my income was, meaning our combined social security checks. Even though I protested, she insisted and filed an application on my behalf.
Weeks later I and my husband received Medicaid cards and a stilted letter than required a phone call to confirm that we both were given Medicaid coverage. My husband bailed on that, since he is covered by the VA. I went about life, an ensured person, seeing my doctor and filling prescriptions amazed at the wonders of health care.
Until about three months went by. We received another letter from Medicaid NM, just as cryptic, requiring yet another phone call, all to confirm that my coverage had been cancelled. No explanation was ever forthcoming other than “somebody had approved your application by mistake”. They saw no reason to explain further.
I placed a call immediately to the Federal exchanges where after numerous apologies for the bonehead play by New Mexico they assured me that the for me, the exchanges were still open (even though it was July) since my original application would be marked as “still open”. They graciously completed my application, told me of my subsidy, and went through the various plans until I decided on one.
I contacted my new insurer, paid the premium and happily my doctor accepted them and life again returned to normal.
Starting in about October I started receiving solicitations from a dozen or more insurance companies for supplemental insurance to Medicare. I was advised that I needed one for sure. Before I could even contact Medicare to see about the process of applying (I would turn 65 in April of 2015), I got official stuff from Medicare.
What a delight I thought. I was “automatically” enrolled in Part A and Part B. It was up to me to decide whether I wanted any supplemental coverage. There was reference to a Part D Medicare for prescriptions I could buy but no mention of cost, other than it would cost something more.
I soon received more official stuff from Social Security, as it related to Medicare. I was told I “might be eligible for extra help in paying for prescriptions”. It had to do with being “low-income” and receiving other “supplemental assistance” of various kinds.
I immediately smelled a rat.
Sure enough an application was forthcoming wherein there was a the laundry list of financial questions that I knew would kick me out. How much do you have in savings and checking? List your investments. What is your mortgage? At the bottom of the form was something to the effect of “I don’t want to apply for Federal “extra help” but send my application to the state for consideration”.
There were no other choices. I sent the form back without filling out ANY of the financial information to conform to the requirement. I assumed that New Mexico would look me up, see that my Medicaid had been cancelled for “ineligibility” and then I could get on to the business of choosing a Part D provider.
I received some weeks later, a letter FROM THE FEDERAL GOVERNMENT (DEPT OF HEALTH AND HUMAN SERVICES, from Maryland) advising me that I had been granted extra help and that I could choose from eight or so carriers. If I chose none, one would be assigned to me.
My frustration started to really grow at that point. I did nothing. A carrier was assigned to me, and I received a lovely packet of information from my new insurance provider and a shiny plastic card to show my pharmacist.
I put off the phone calls that I knew were necessary, and finally steeled myself to that event yesterday. I gathered all the various pieces of information, made sure I had all the identifying documents at hand, and called Medicare.
I explained that I had been given “extra help” for Part D coverage, and that I was, in my opinion not entitled to. I was even over the cut off based on my social security alone, without adding in our savings and investment portfolio. I was advised that New Mexico had granted the “extra help” and that Medicare couldn’t remove it. I was given the number to NM Medicare, which is not really Medicare at all, but Medicaid.
That call resulted in being told that “they had nothing to do with it at all, and I must deal with Medicare.
I called back Medicare.
I called back Medicaid NM. Same answer.
I called back Medicare. Same answer
I called back Medicaid NM. This time they told me I needed to call NM Health and Human Services.
I did. Their menu had nothing about Medicare at all as far as I could see.
I called Social Security, “extra help” division. They gave me a history lesson in Medicare/Medicaid, and after assuring me they would help, told me that the document I had entitled Health and Human Services, from Maryland (denoting the US govt) was from New Mexico. I was advised to call NM HHS.
I called NM HHS. They actually looked up my old file, which is still current because at the age of 64, I still am able to receive family planning care at the state’s expense. If I’m ever declared as having a post-menopausal pregnancy, I’ll be the first to tell them and the world. She informed me that NOBODY there deals with anything like “extra help” nor Medicare. We didn’t do it she insisted.
I got in the car, drove to the Social Security Office. I explained my situation. “They are trying to give me extra help based on a mistaken belief that I am too poor to be required to pay,” I explained. They will come to correct that in a few months, and that might leave me without coverage, and my prescriptions are expensive. I am trying to clear up the problem now.”
He looked at me like I had landed from Mars. “So, he said, “you are getting Part D coverage but you don’t want it?”
“NO! It’s not that I don’t want it. I would love to have it. It’s just that I don’t think I qualify for it, and I don’t want to be stuck with no coverage when they inevitably figure that out. NOBODY will acknowledge that they gave it to me, so I can’t even discuss the qualifications with anybody. If by some miracle I am entitled, I’m happy to have it. But I can’t find that out until somebody admits they granted it. Somebody put an “approved” stamp on this. I’m trying to find that person/entity.”
“I’ll see what I can do.”
He made a phone call. He called the new insurance carrier and said, “she is covered by you, but doesn’t want it.”
I demanded the phone.
I gave her the information, “my insurance number”.
She looked up the file. She said, “there was a cross over from your Medicaid coverage directly here.”
“But my Medicaid coverage was cancelled.”
“I understand what you are saying, but they did it anyway.”
“Who is they?”
“It does not say. It appears that your status as having Medicaid caused a cross over.”
“But everybody denies they did it.”
“Ma’am I do understand. I can cancel it if you wish, but that may open a can of worms for you in trying to replace it. There is on its face no justification for refusing it, and so they might not give you other discounts. I really can’t say. I’d just advise you to leave it be.”
I looked at the Social Security guy across the table from me.
“I give up.”
“I’ve called everyone, talked to everyone. No one will admit they approved my being placed on this plan, so I can’t even ask the question of on what basis I’m entitled. I was here. Note that in my file. I’m done.” He smirked as if he had won the battle on that one.
Here I stand, beaten. I thought I was being an honorable and honest person. The system does not reward honesty, it laughs at it. This stands as a testament should I ever be called to answer for my crime of trying to do the right thing.
Please tell me you have run into equally stupid bureaucratic bullshit?
It is obvious that you are being punished for sins in another lifetime 🙂
oh, well that explains it. I figured it was more that bureaucracy is loaded with stupid people. I still tend to that explanation. !END
Medicare has been simple and easy for my wife, she doesn’t get Social Security because she did not fill work quotas, but she received Medicare no problem. The Private cornucopia of stuff we did receive, she was lucky and had a carrier already which she kept for extra fee.
well I’m glad that it worked out for you…lol…I guess for some it must otherwise the entire capital would be surrounded by people carrying pitchforks. !END
I cannot fathom. I’ve watched my FIL go round and round with what parts he’ll have and the benefits and drawbacks of each, and I am surprised that anyone can make sense of it. It does sound to me like NEW JOBS could be created!
my husband is still reading what my coverage is and trying to figure out if I need supplemental insurance (you have 4 months from the start date before your out until the next enrollment period…He said a genius cannot figure this stuff out….I cannot fathom why it must be so damned difficult. !END
It sounds like you have a need for a Rx plan Sherry. I am not in that position yet. I have refused to sign up for Part D and have instead taking part or all of the money I would pay on a Rx drug plan premium and put it into my savings account, using it as the need arises.
Had I had some serious issues that required multiple prescriptions I would have signed up for Part D when I became eligible for medicare. Of course I may have to confront this down the road as I get older at which time it will cost me more to sign up then. But I’ll cross that bridge when I get to it
Well as long as I keep getting the “extra help” it’s great. I pay no premium at all and just the usual co-pays which don’t amount to much. Right now I’m paying about 8 bucks a month for my co-pays so it seems it will be about the same. And I have 3 more months after April 30 before my window of purchase is closed until October or something when the enrollment period opens again. So all in all, I should be okay even if they cancel it after three months or so..My doctor says I can purchase my prescriptions there at the clinic as well through some plan they have with Medicare…It’s all more than I want to understand…lol..!END
Reblogged this on kingfo.
Amazing how screwed up bureaucracy can be… totally FUBAR! And in the end, they’ll blame it all on you and fine you for this criminal act.