CRITICAL QUESTIONS DEMAND CRITICAL ANSWERS

When you have a change in your health insurance eligibility, it is of the utmost importance that you are given the correct answers to your questions. Therefore, it may be necessary to make more than one phone call to make sure you get the same answer twice.

For example, we were completing an application for health insurance for an individual who had lost her job and stayed on her former group plan as long as she could under the COBRA law. When the COBRA coverage ran out, she did not buy individual coverage immediately because she was told that she could have a gap in coverage of 60 days without incurring a waiting period for preexisting conditions. She has preexisting conditions so she should not have exposed herself to a great financial risk by not having coverage for several months. When she applied for the individual coverage, I had to tell her that she would have a waiting period for preexisting conditions because she could only have a gap of 30 days without coverage, not 60 as she had been told. What is so unfortunate about this is that she called an insurance company for the information and was given the wrong answer! When you go from a small group to another small group, you can have a gap of up to 90 days without coverage (in NJ) but when you go from a group plan to an individual plan in New Jersey, the gap cannot exceed 30 days.

In a situation such as this, when it is imperative that there not be a waiting period for preexisting conditions, it is always best to make two phone calls. Call the same number again, a bit later, speak with a different company representative and see if you get the same answer. You may even have to call a third time, especially if you get a different answer.

Another good example of critical questions requiring critical answers pertains to individuals who continue to work beyond their 65^th birthday. When you inquire as to whether or not you need to sign up for Part B Medicare, make sure you get the same answer more than once. We have seen cases where people were working for a company with more than 20 employees, beyond their 65^th birthday, and they had Part B Medicare in addition to their group health insurance. The group health insurance is primary and Medicare is secondary. However, when these people eventually retired, they wanted to buy a Medigap policy with prescription benefits and couldn’t because they were already on prescription drugs and had Part B Medicare for more than six months.

Our last example deals with those folks who refused Part B Medicare because they were working for a large company and they didn’t need it. However, when they retire the ballgame changes. I am thinking of one gentleman in particular. Some folks told him he needed to apply for Part B and others told him he didn’t have to do a thing; he would just get it automatically. When you are collecting Social Security retirement income prior to age 65, you will automatically get Part B but if you continue working beyond your 65^th birthday, the government has no way of knowing when you stop working. You must contact Social Security and apply for it. The individual I have in mind was just confused by the information he was hearing so he just put it off. Unfortunately, he ended up in the hospital with only Part A Medicare, in the month of April. The hospital bill was covered, all but the deductible. But none of the medical bills were covered. When you don’t apply for Part B to be effective the date of your retirement (or the month in which you turn 65), you can only apply for Part B in January, February or March and it doesn’t become effective until the following July. This person had to do without Part B Medicare from April 2002 until July 2003! You don’t want that to happen to you.

When the answer is of the utmost importance to you, make sure you get the same answer twice.

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.

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