A Medicare Nightmare

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After spending time training in a primary care office, it became clear that we're doing no favors for the health of our nation's seniors. Medicare is confusing. From talking with  patients, I found that the average senior spends 40 hours trying to figure out how to enroll in Medicare. What's worse, if they make mistakes during the enrollment process, they can be required to pay penalties for the rest of their life. 

At its worst, the complexity of Medicare can place people at the mercy of its many rules and loopholes. To illustrate, I’ll share one of the many stories we encounter here at Doctor’s Choice. Last year we worked with a client, who I’ll call “Steve.” Steve encountered a terrible situation that could have been avoided had his company been more informed on the rules of Medicare. 

After a long and successful career with his company, Steve was given the devastating news that he had cancer. 

As he and his family went through his treatment options, he decided that it would be best for him to scale back his work while he was undergoing chemotherapy. When Steve shared this news with his company, they were nothing short of supportive. Together they agreed that the company would help to support him going on an extended medical leave, an offer that Steve greatly appreciated.

As part of this agreement, Steve’s company offered to pay for his healthcare coverage for 18 months, in addition to offering him a generous severance that would help to carry him through his illness during treatment and recovery. 

Prior to his diagnosis, Steve turned 65. 

Steve thought nothing of this milestone from a Medicare perspective since he had healthcare coverage provided by his employer. His company was paying for his COBRA benefits, and his coverage was active until May 1.

The problem that he didn’t know at the time is that healthcare coverage through COBRA is not considered “creditable” coverage by Medicare, making him subject to penalties and a limited time frame when he could enroll in Medicare.

Steve began the Medicare enrollment 6 months before he needed coverage, thinking he was leaving more than enough time to secure coverage by May 1, the date when his healthcare coverage ended. He was baffled to learn that he could only sign up during Medicare’s General Election Period, so he couldn’t get Medicare coverage until July 1. This would unfortunately leave him uninsured for 2 months. And as he was still undergoing cancer therapy, any lapse in healthcare coverage would have had a devastating financial impact on his family.

Thankfully this story has a happy ending because he reached out to Doctor’s Choice. After extensive advocacy, we were able to successfully appeal his case to ensure Steve was able to get the healthcare coverage he needed without having a lapse. As the average person would have no idea that an appeal was an option and would not know how to go about this process efficiently, we were glad to be able to expedite an outcome in Steve’s favor.

Unfortunately Steve’s story is not unique. We encounter countless situations when a well-meaning employer offers a severance package for someone around age 63 without realizing an impending issue the individual will encounter with Medicare. The big takeaway for employers, and also for employees, is to have any severance, retirement or phased retirement packages reviewed by a company experienced in Medicare compliance (such as Doctor’s Choice.) We believe that making the right choices for our health should be easy. By serving seniors with integrity and providing them with personalized, unbiased guidance, we fulfill our mission to make Medicare easy, and actually enjoyable for people when they enroll.

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About Doctor’s Choice:

Doctor’s Choice is the premier service advocate for Medicare, making healthcare transitions easy for employers and their employees. Founded by a Brown University-trained Physician, they deliver best-in-class service to seniors before, during and after their transition to Medicare. Offering coverage across the country and tech-enabled personalized guidance through their Turbo Medicare Roadmap, Doctor’s Choice provides concierge-level service and healthcare advocacy to our members for life. For more insights on retirement trends and employer strategies for an aging workforce, follow Doctor’s Choice on LinkedIn @DoctorsChoice, Twitter@DoctorsChoiceU, and Facebook @DoctorsChoiceUSA.