Group Coverage Back-Dating Cancellation

[StephanieCJ]

Scenario: Client said she intended to retire and wanted to get Medicare in place April 1. Local SS office lost the application that she walked in and put in their drop box back in February. Client then faxed it in during the month of March, but they did not process it until after she called (which was after April 1). We did MAPD to start on 5/1 once we got the Part B approval confirmation. She called her group today and they told her that today is the last day to end her group coverage, but that they will back-date the cancellation to April 1.

Question 1: Does it sound right that they would back date the cancellation to when Medicare started?

Question 2: She has picked up prescriptions this month, so I'm assuming that the insurance company will do a claw back. Can the pharmacy attempt to collect the money from her?

 

[LeeV]

Maybe I am confused. If she has other coverage in place as of 4/1, why do you question if the group carrier was correct in backdating the cancelled coverage to 4/1? Is that not what she wanted? Backdating is allowed.

As for the claw back, more than likely, the group plan will adjust its provider payments in the following months to recoup any amounts paid during April. And since the provider can ask for payment from her.

 

[StephanieCJ]

I assumed the clawback would be a thing, question is if the pharmacy would try to collect from her. Technically, she didn't have other coverage in place 4/1; Medicare backdated coverage to 4/1, which didn't allow her to get Part D coverage because B wasn't effective and group had not ended yet ( group ending plus have allowed for SEP for ICEP to get Part D).

 

[sman]

I assumed the clawback would be a thing, question is if the pharmacy would try to collect from her. Technically, she didn't have other coverage in place 4/1; Medicare backdated coverage to 4/1, which didn't allow her to get Part D coverage because B wasn't effective and group had not ended yet ( group ending plus have allowed for SEP for ICEP to get Part D).

I'm assuming the pharmacy can ask her for the money that was/will be clawed back. Do you know if she paid a premium for her group plan for the month of April? If so, is her employer going to reimburse her for that since they are back-dating it? Does she have the option to have the group coverage go through April (no back dating)?

 

[LeeV]

I assumed the clawback would be a thing, question is if the pharmacy would try to collect from her. Technically, she didn't have other coverage in place 4/1; Medicare backdated coverage to 4/1, which didn't allow her to get Part D coverage because B wasn't effective and group had not ended yet ( group ending plus have allowed for SEP for ICEP to get Part D).

Do not hold me to the exact timelines, but the pharmacy will not know for a month or so about the reversal. I do not know their policy, so I have no idea if they will reach out to her and ask for payment, but they are within their rights to do so.

 

[StephanieCJ]

Turns out the person she spoke with was incorrect. She called back and got a different person who said they would not backdate the cancellation (which I thought was the case). Ultimate source of the problem is SS offices not processing delayed Part B applications when they receive them and/or losing them.