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Mikayla Sorge, EBS of Wood County, helped a client keep his Medicare Savings Program benefit. During the Public Health Emergency, the client had been receiving MAPP and QMB. During the PHE, he had cashed out a pension and reported it to IM timely. During the PHE unwinding, he received notice that his renewal was scheduled for May 2024. This meant that he should continue to receive MAPP and QMB through this time. However, the client received a notice that due to his pension, he was now only eligible for SLMB+, and because a person cannot have SLMB+ and MAPP at the same time, he would need to choose one or the other. This was incorrect, however, because his benefits should remain unchanged until his renewal date. Mikayla contacted IM and was able to resolve the issue quickly without needing to escalate it with the ForwardHealth Partners Inbox.
7/27/2023
Story #97
Kenton Zink, EBS in Dane County, recently met with a farmer who had lost QMB eligibility and had fallen behind on Medicare premiums. He had also received confusing letters telling him that he had lost BadgerCare coverage even though he continued to be eligible under Public Health Emergency rules. Amidst all the concern and confusion over his health insurance coverage, the client had been delaying reconstructive oral surgery to help repair damage from cancer treatments. Kenton worked with the Medicaid Buy-In Analyst to reestablish premium payments through the Medicare Savings Programs, helped reassure the client that his BadgerCare coverage remained in place so he could proceed with reconstructive care, and helped the client get approved for MAPP so that he will have reliable secondary coverage when his BadgerCare eligibility ends.
2/28/2023
Story #63
Mindy Shrader, EBS in Sauk County, recently received a favorable decision from SSA on an appeal of a client’s Medicare start date. The client was QMB eligible, and Mindy helped the client request conditional enrollment into Part A in April 2021. Her QMB enrollment started June 1, 2021. Unfortunately, SSA ignored the conditional enrollment request, and started the client’s Medicare before her QMB started, even though the client did not have a SEP and was not in a Medicare enrollment period. The client is not eligible for premium-free Part A, so this left her with a very large premium bill. When SSA was unable to fix this, Mindy helped the client request reconsideration. After many months in the processing center, the client received an updated Medicare card with the correct start dates and a letter explaining that she no longer owed any Medicare premiums.
Monetary Impact = $510
5/31/2022
Story #14