BCBS has sent letters stating my wife didn’t have drug coverage for some months last year and warned of a lifelong penalty for enrolling in Part D. This isn’t true because our joint policy covers her medications. What’s happening with BCBS? My wife has spent hours trying to resolve this with both Medicare and BCBS. I’m eager to leave these guys when the year wraps up. This mess began after I retired from the federal government in 2020.
Your previous drug coverage came from your FEP plan. Just let them know that you had creditable coverage from another plan back then. Other types of coverage aren’t usually reported to Medicare, so they’re reaching out because they need confirmation for possible Late Enrollment Penalty.
It looks like you’ll need to get more info from BCBS and Medicare about what happened. It’s tough to find answers without additional details.
What type of medical plan do you have? If it’s got a really high deductible, it may not count as creditable coverage.
Jamie said:
What type of medical plan do you have? If it’s got a really high deductible, it may not count as creditable coverage.
The deductible isn’t high at all. It’s a ‘Basic’ FEP.
@Vail
You should reach out to FEP and check if she was part of the ‘MPDP’ program. This has led to many issues. If she was, opting out might help. It might clarify how to handle any pending claims.
Here’s a link with more info: FEP Medicare Prescription Drug Program - Resources - Blue Cross and Blue Shield's Federal Employee Program
This situation might have been missed if not for keen attention. If she was enrolled during that period, ensure her prescriptions were processed via MPDP.
@Haru
Exactly, that’s the problem. BCBS had the necessary paperwork but hadn’t forwarded it to Medicare. She opted out of the MPDP during the call.
Vail said:
@Haru
Exactly, that’s the problem. BCBS had the necessary paperwork but hadn’t forwarded it to Medicare. She opted out of the MPDP during the call.
Did you send the form directly to MPDP?
FEP customer service isn’t the fastest option for answers. It could take longer going through them.
If you’d like, I could see if there’s a faster way to send it, maybe by email or fax.
Let me know how else I can assist.
Do you have a Medicare Supplement plan with BCBS? If so, you’ll need a Part D plan as well.
Cody said:
Do you have a Medicare Supplement plan with BCBS? If so, you’ll need a Part D plan as well.
No, my BCBS-FEP plan doesn’t connect with Medicare.
Cody said:
Do you have a Medicare Supplement plan with BCBS? If so, you’ll need a Part D plan as well.
No, my BCBS-FEP plan doesn’t connect with Medicare.
COBRA isn’t Creditable Coverage for Medicare. So they are correct that she didn’t have creditable drug coverage.
When someone loses employer health insurance and moves to COBRA, it doesn’t count as equivalent to Medicare coverage. If you’re on COBRA and eligible for Medicare, there could be penalties if you delay enrolling in Medicare Part B and D.
@Cody
Sorry for the mix-up, I wanted to say it is NOT COBRA.
@Cody
COBRA isn’t Creditable Coverage for Medicare Parts A and B. But a COBRA plan can be creditable for Medicare Part D. CMS states:
Coverage is creditable if the value of the coverage equals or exceeds the value of standard prescription drug coverage under Medicare Part D, as confirmed through accepted principles and CMS guidelines.
Take a look at these resources:
- CMS page on Creditable Coverage
- PDF on the CMS page, ‘What is Creditable Coverage’.
Just having drug coverage doesn’t mean it was creditable coverage. I think that’s where the issue could be. Your employer sends a report each year to CMS indicating if their plan is creditable or not.
Could you clear something up for me?
Did you switch insurance last year? Did you start the year with BCBS-FEP and then move to another BCBS plan?
If that’s the case, your current plan is reflecting that your wife was covered only part of the year because that’s how long the policy covered. Your previous plan should have confirmed creditable coverage. I’d recommend asking for the FEP disclosure (request the disclosure of prescription drug creditable coverage as detailed in 42 CFR §423.56(e)).
If that’s not the situation and you had the same plan the whole year, there could be an error. If you were under a BCBS-FEP plan all year, it should definitely qualify as creditable for Part D. More details can be found at FAQ for BCBS-FEP.
I’d suggest asking BCBS why they say the FEP plan isn’t creditable for Part D and request the analysis supporting that claim (you can find more info at CMS “What is Creditable Coverage” regarding the definition of what makes it creditable).
Simply call BCBS and mention that she needs an ‘attestation of creditable coverage.’
They should have provided a page for this, where you check a box about employer coverage. If that didn’t happen, you can handle it over the phone. Medicare doesn’t have info on anything other than standard Part D or advantage plans. When you have coverage from different sources, it’s important to inform them. Let them know during the call that she had creditable coverage through your employer plan along with the dates she was covered.
Did I bring up how dishonest some BCBS employees can be on the phone?
Is it a managed care plan? Managed care plans can act as middlemen, often leading to frustrations as they operate under Medicare rules but function like probate insurance. Medicare pays BCBS for their services.