Weird Late Enrollment penalty issue PDP

I have taken this statement:



In this link:
Part D late enrollment penalty | Medicare

To mean that the Medicare PDP computes the Part D LEP according to Medicare rules and administers its collection on behalf of CMS/Medicare.

If they decide you owe a penalty I think they are supposed to send you a form which lets you show them that you have creditable coverage during the period they are charging a penalty for. At least that was my personal experience with my first PDP assessing a penalty--and--I think we have had discussions in some other threads about submitting this information to plans, not to Medicare, for penalty abatement.


Yes this is what he did when he first got medicare

This time they are not asking for this they are just saying this is what it is


He may have strayed it out, Yesterday I told him to call them one more time ask for a manager if it does not get fixed I will help you with the appeal

He has not called back so I am guessing he fixed it

Though i may get a call today or tom
 
If you get a callback, advise him to call all previous carriers and ask if he was billed for an LEP. Start from scratch to figure out when it was charged. I'm sure he missed some mail or something.
 
If you get a callback, advise him to call all previous carriers and ask if he was billed for an LEP. Start from scratch to figure out when it was charged. I'm sure he missed some mail or something.


Yo really think I didn't do that already? He certainly has not been paying a $37 penalty
 
I was in the midst of composing a reply to InsByAccident earlier this morning-this is a strange situation indeed. I question if this isn't a SNAFU on WellCare's part. I have been having some strange enrollment problems with two clients who were on the Value plan in 2021 and kept on the plan when WellCare changed it to the $63+ plan (instead of mapping the entire membership to $15 plan and had the members who WANTED the $63+ plan to enroll in that specific plan…but I digress). I have two clients who are enrolled in BOTH plans, and what a mess this has caused.

So, my suggestion is contact Medicare with your client and have his information from his employer plan handy. If the problem is with Medicare, you both may be able to identify where or what the missing dates are. It is highly unlikely (in my humble opinion, that Medicare is catching up him now, but not totally impossible). If all is well with CMS, then it is a WellCare system issue.

That's my $0.38 worth - $0.02 with inflation
 
I was in the midst of composing a reply to InsByAccident earlier this morning-this is a strange situation indeed. I question if this isn't a SNAFU on WellCare's part. I have been having some strange enrollment problems with two clients who were on the Value plan in 2021 and kept on the plan when WellCare changed it to the $63+ plan (instead of mapping the entire membership to $15 plan and had the members who WANTED the $63+ plan to enroll in that specific plan…but I digress). I have two clients who are enrolled in BOTH plans, and what a mess this has caused.

So, my suggestion is contact Medicare with your client and have his information from his employer plan handy. If the problem is with Medicare, you both may be able to identify where or what the missing dates are. It is highly unlikely (in my humble opinion, that Medicare is catching up him now, but not totally impossible). If all is well with CMS, then it is a WellCare system issue.

That's my $0.38 worth - $0.02 with inflation

(caveat, not an agent)

I think it would be much more direct to just get WellCare to send him the form to list out prior creditable coverage. (or for their customer service to take the information over the phone like SilverScript did for me some years back.)

He will have to provide that information to do an appeal and it would just be quicker if he can get wellcare to take it directly from him instead of from the appeal contractor as an intermediary.

He should be able to get the recap level of information he needs from his MyMedicare account.
 
(caveat, not an agent)

I think it would be much more direct to just get WellCare to send him the form to list out prior creditable coverage. (or for their customer service to take the information over the phone like SilverScript did for me some years back.)

He will have to provide that information to do an appeal and it would just be quicker if he can get wellcare to take it directly from him instead of from the appeal contractor as an intermediary.

He should be able to get the recap level of information he needs from his MyMedicare account.

There are rules around when a plan can accept an attestation from an enrollee. If Wellcare sent the letter saying the LEP was previously assessed they can't accept an attestation at this time (even if they were the plan who did the assessment unless they realize they screwed up).

I would take a 2-step approach at this time -- go through the grievance process with Wellcare to have the LEP researched. And go through the appeals process with the CMS contractor.

And if you're really bored....
Creditable Coverage and Late Enrollment Penalty | CMS
 
YEa WellCare told him he cannot just do attestation He needed to get all documents and send Direct to CMS

Fortunately he has everything but who knows how long it will take
 
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