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Kathy Schultz, EBS of Langlade County, helped a client eliminate her Medicare Part D Late Enrollment Penalty. The client was assessed a Part D LEP because it did not have the information regarding her SeniorCare coverage. The client's friend had tried to help her appeal, but thought the Part D LEP was assessed because she was late on her Part D premium payments (which she was not). After receiving a denial, they came to Kathy, who helped her submit another appeal with the correct proof of SeniorCare coverage dates. C2C Solutions, however, gave this appeal a new number and denied due to it being past the appeal deadline. Kathy worked with her BSSA to draft a good cause late appeal based on the client's diligent work trying to resolve the issue since January. C2C Solutions ultimately agreed, and nine months later her LEP was removed.
9/29/2023
Story #112
Terri Esselman, EBS of Clark County, helped a client negotiate a $10 per month repayment plan with SSA for an SSI overpayment. The client was incarcerated, and had incurred an SSI overpayment totaling over $2,000. The client did not deny that he was overpaid, and did not want to request a reconsideration or waiver. Instead, he just wanted to reduce his monthly repayment amount so SSA would not take his full checks. At first, SSA told the client the lowest amount they could accept was what could be repaid over 12 months, then they said 36 months. However, Terri was able to use the POMS rule that a person receiving LIS (Part D Low Income Subsidy) qualifies for a repayment amount as low as $10 per month. After educating SSA about this policy, he was granted this repayment amount and can now pay it off slowly over time as he re-enters the community post-incarceration.
8/31/2023
Story #104
Nyna Frelich, EBS in Brown County, was successful in helping a 69-year-old woman save
thousands of dollars in medical bills. The client came to Nyna in December of 2022
for help with medical bills from a hospitalization the month prior. This client only
had Medicare Part A. She had several prescriptions that she could not afford after the
hospitalization and very high out-of-pocket medical expenses.
First, during OEP, Nyna helped her enroll into a Medicare Part D prescription drug
plan to use in the new year. Nyna also helped the client apply for EBD Medicaid with a
deductible. This client's deductible was about $4,500. Nyna helped the client submit
medical expenses to Economic Support (ES), but they did not apply the medical expenses
to her deductible in the correct order according to the MEH.
The way ES entered the medical expenses meant she would have had to pay the majority
of the deductible out-of-pocket, whereas if ES entered the expenses in the correct order,
she would not have. Nyna asked ES to reenter the order of the medical expenses, but they
refused. With the help of her BSSA, Nyna filed a fair hearing and typed an argument including
MEH references for how the medical expense should be entered to meet the deductible. ES
corrected the case before it went to hearing. Because ES reentered the order of the medical
expenses, the client's hospital bill remained unpaid by Medicaid. However, the client was
able to apply for financial assistance for those bills. Since the hospital was willing to
write off some of her medical expenses, the other medical providers were also willing to
write off her medical expenses. We were able to get much of the deductible amount written
off with financial assistance, and get the remainder covered by Medicaid.
In January, Nyna used the GEP to help the client apply for Part B and helped her enroll
into a MA plan. She is now fully covered with Medicare and will have Medicaid continuous
coverage through August 2023 due to the PHE. She will also have full LIS/extra help through
the 2024 calendar year. By working with Nyna, this client was able to save thousands of
dollars on past medical bills and become fully covered for any future medical expenses as well.
Monetary Impact = $4,500
5/31/2023
Story #77
Emily Reuter helped another client untangle a complicated Part D enrollment mess. The client had been disenrolled from his Part D plan when another beneficiary with the same first and last name chose a new plan during the 2022 fall Open Enrollment Period. Medicare and both plans had mixed the two beneficiaries up even though they had different middle names and Medicare ID numbers! The CTM took over a month to resolve, as Medicare and the plans were still confused about the situation, but the client was eventually reenrolled into his plan.
5/31/2023
Story #74
Leda Welke Judd, EBS in Eau Claire County successfully helped a client with an out-of-network Part D drug reimbursement. Leda had helped answer the client's questions when she initially started on Medicare, so the client returned to her when she was having problems. The client had had surgery over the summer of 2022, and the insulin she received while in the hospital was not covered by Medicare A and B. Her bill for the insulin was $360. The client had tried calling her Part D plan on her own at first to ask about coverage, but she was told that since she had switched plans during open enrollment period, the item could not be covered. However, Leda knew that was wrong, so she helped the client call the plan back together and the plan agreed to send out the Out-of-Network Reimbursement form for the Part D plan. Together, Leda and the client completed the form and sent it in. The client received $291 reimbursement back from the plan for the coverage of the insulin. The client was thrilled and wrote a letter to Leda detailing her appreciation.
Monetary Impact = $291
4/28/2023
Story #71
Angie Pietroske, EBS in Kewaunee County, helped a client resolve her Part D plan issue through a CTM complaint with Alyssa Kulpa's help. Angie met with this client during AEP and helped her select a Part D plan. The planfinder showed that her pharmacy was in-network for the plan selected. However, when the client went to the pharmacy she learned that it was not in network for her plan. Unfortunately, this was the only pharmacy within reasonable driving distance for this client, not to mention the fact that it's a pharmacy the client knows and trusts. Alyssa helped Angie submit a CTM complaint due to the planfinder error to get the client into a plan that has her pharmacy in-network. Within four days, the CTM complaint was resolved, and the client was switched into a plan that works for her.
2/28/2023
Story #61
Joanne Welsh, EBS in Richland County, helped a client successfully appeal his Part D late enrollment penalty. The client had been on SeniorCare for a number of years but had not filled out the plan's paperwork correctly to report the creditable drug coverage. Joanne helped the client appeal to C2C Solutions, which found that the client was not required to pay a late enrollment penalty.
2/28/2023
Story #55
Jessica Knippel, EBS in Manitowoc County, helped a couple who each had a late enrollment penalty with their respective Part D plans. The husband and wife, who are 70 and 69 years old respectively, both had SeniorCare for drug coverage for many years. They recently enrolled in Part D plans during open enrollment with two different companies. Neither company accepted SeniorCare as creditable drug coverage and assessed each spouse a late enrollment penalty. Jessica helped both spouses appeal the late enrollment penalties and quickly received favorable results on both.
11/30/2022
Story #45
Leda Judd successfully helped a consumer receive SSI and SSRE with a backdate.
The consumer called our office because he hasto pay $1.35 per med and wants to go back
to using his Foward card since he had $0 co-pays. A referral was made to me on June 2, 2022.
I checked Cares prior to calling him and he had no income. He is 66 years old and turning
67 in the fall. During our conversation, he said he lived with his sister and in return
for rent he helped with their mother who had Alzheimer's. I asked him why he did not have
any income and he said he wanted to maximize his social security retirement benefit and
wait until his full retirement age to take SSRE. He said, according to SSA letters he
received, if he took it now it would be $337/m . If he waited until he was 70, it
would be $537. He had wanted to decline Medicare and stay on Medicaid only. I explained
he could not do that because he is entitled to Medicare at age 65. He was auto-enrolled in
to an LIS Part D plan because he had been on BC+. He said he can't ask his sister for any
more money, not even $1.35 for medications. I felt if he had income, he would be able to pay
for his medications and help out with household expenses. He agreed. We then discussed calling
the Social Security office to schedule an appointment to collect his SSRE AND apply for SSI so
he could receive his maximum benefit. When I did the math, I felt he would receive a total of
$861, which includes SSRE of $337 + $524 SSI. Plus the SSI state supp of $83.78. He would need
to claim shelter costs to get the state supp of $83.78. He said he would pay his sister rent if
he had money to pay her. We called SSA on 6/2/2022 and scheduled his appointment to apply for
SSRE and SSI. A phone apt was scheduled for June 24, 2022. I received an email from the
consumer that he was approved for SSI on July 5, 2022. "Great news! My SSI application was
accepted. I received payment already of $3400 today." He also stated that he will get his
SSRE and there will be a backpay but he was not given an amount.
Since this time, he has received several letters which are confusing and have conflicting
information. We called SSA to help us with understanding the letters. I explained he received a
letter reducing his SSI amount to $64/m for September. The rep at SSA assured us it will be all
straightned out by October. He then received a letter dated August 23, which states he has an
overpayment for SSI in the amount of $531. He did not want to file for a waiver or appeal due
to his mental health issues. I will continue to monitor this case and help him if he changes
his mind and wants to request a waiver or appeal.
I feel this story was important to point out because of the impact our program has. A person
may call for one issue and after we ask a few questions, realize there is a larger issue that
we can help with. Monetary impact is confusing because of the recent overpayment. I should
record $861 x 12 = $10,332 x 4 (years) = $41,328. If he had not called our office, he would
have most likely waited until he was 70 to draw on his SSRE benefit of $537. This is one of
the largest monetary impacts I have recorded. I have not closed this case because of the
overpayment but the person was approved for SSRE and SSI with backdates on 7/5/22.
Leda
Monetary Impact = $41,328
7/5/2022
Story #23
Mary Velcich, EBS in Green County, recently helped a client straighten out an issue with the IRMAAs he and his wife were paying for Medicare Part B and Part D. The client was confused about the Medicare premium bills he was receiving, because the amount billed didn't match what he thought he would be paying for his Part B premium and IRMAAs. After a phone call with SSA, Mary learned that the client was being charged an IRMAA from the correct income category for Part D, and an IRMAA from a higher income category for Part B. After talking with the client some more, Mary learned that he had recently retired. Mary helped the client fill out an SSA-44 to reduce the couple's IRMAAs going forward because of his retirement. She also sent a letter to SSA asking them to correct the IRMAA amounts he had been paying. A little over two weeks later, the client let Mary know that the IRMAA issues had been fixed and that this will save the couple approximately $8000.
Monetary Impact = $8,000
7/28/2022
Story #21