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My dad has been working part time for a company that in addition to his token salary, they pay for both his and my mom's supplemental health insurance. We just found out (through a claim denial) that my mom was dropped from her plan in October. As far as we know she never received notification (but it might very well have been tossed by mistake) and my dad's company never disclosed this. I'll be going to their home tomorrow to try and straighten this mess out. Question is...does anyone know if the insurance co. (American Republic) is obligated in any way to re-instate her? I know the closing date was 12/7....is there anything I can do to gain coverage elsewhere if she is denied? My dad also fears he will be dropped on the first of January and will be scrambling as well to find coverage. They are 89 and 90 and mom has numerous health issues. Dad is holding his own for the time being, but to be without supplemental insurance this could be disastrous.

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Update on the insurance issues....and found some pertinent info that might help others whose Medigap insurance that lapsed.

Thanks for the responses......after having to send in my POA to the insurance co. I contacted dad's place of employment. Unfortunately the ball was dropped and the payment due was ignored for that particular quarter by his employer, but was paid once it came to their attention. The insurance co. still insists mom was past the 60 day reinstatement period and would have to reapply and sent to underwriters, and could be denied coverage for pre-existing conditions (what 89 year old doesn't?) while being penalized by much higher premiums. This is still an ongoing conversation.

In the interim, while doing my own research, I found out that if the open enrollment cut off is missed or your Medical supplemental insurance has lasped .....this is indeed the protocol. EXCEPT in the states of Ct.,N.Y.,Ma. and Maine (Me. having some restrictions). The above mentioned states are Guaranteed Issue states, as long as the policy hasn't lapsed for more than six months. So....good news since we live in Ct. (at least there is some benefit living here). Worse case scenario we can get a new plan for mom without the scrutiny of underwriters for the open enrollment premium cost. But, if American Republic (out of Iowa) refuses to reinstate mom I will make a formal complaint to the insurance commissioner. Of course none of this is disclosed which makes this whole Medicare/Medigap circus even more confusing. As always ...... you are your own best advocate.
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So Abby, have you been able to talk to anyone at dads company yet to find out why mom's premium wasn't paid?

Wworried, I think what Abby meant was that it would be a shame to pay extra for hospitalization and medications that are supposed to be covered by insurance.

Her parents ARE using their own money to pay for their care/housing. Ultimately, they need placement (which they are fighting) but which will be private pay. THAT'S what the funds are needed for.
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Abby2018 Dec 2019
Thank you for clearing that up!
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You said Dad gets a "token" salary. Does this mean he is paid "under the table"? If so, Dad may not be entitled to benefits. I am surprised that he us still working at 90. God Bless him.

As said, an employer is not responsible to pay premiums for p/t employees.

How is ur parents income? Maybe they will qualify for Medicaid healthcare.
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Abby2018 Dec 2019
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Abby: In your first sentence " they (employer) pay for for his and my mom's supplemental health insurance" so it sounds as if they dropped the ball. Or is is that the employer pays a% and your parents pay the rest of the premium ?
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Abby2018 Dec 2019
Employer pays the full supplement premium.
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As an employer who covers my employees I'm trying to figure out how this happened... the employer certainly can't just drop people without informing them. Was your dad working full time and then moved to part time recently? Employers don't usually provide medical benefits to part-time employees. Was there a change in ownership of the business? They could have changed the benefit package (but still would have had to notify people prior). Is the employer in financial straits? Maybe they couldn't make their premium payments? I would ask the employer to prove they sent out a notification to your parents. It's such a weird time of year to drop the insurance...I don't know much about Medicare supplemental insurance but it doesn't seem that expensive. At their age it wouldn't be out of the realm of possibilities that your parent accidentally threw out the notice. Good luck, I hope you get answers quickly!
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Can you pay the past due amount and get her reinstated?

I would also verify where they are sending notices, this could be going to an HR person that just circular files it because they don't recognize the name. Make sure that your parents address is in their system.

It is difficult to get other insurance when you have been cancelled for nonpayment, you really want to get this taken care of, even if they have to pay.
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How is it that mom's premium didn't get paid? Who was responsible for doing that?

Is it still within 30/60/90 days? Can you throw yourself on the company's mercey? Contact their president or CEO if necessary.
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Ababy, I'm assuming both parents have Medicare Part A and B and this is their Medicare supplement?

I would not assume mom has been dropped. It may be that the claim has not yet gone through the Medicare part B claim process.

Call the supplemental plan tomorrow and dont say "dropped". Simply inquire why the claim was denied and how the claim can be resubmitted.

If indeed the policy has been dropped, please use this as an opportunity to browbeat your father into submission about getting him and mom into care so that mistakes like this don't happen
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Abby2018 Dec 2019
Thanks Barb....the insurance company has confirmed to my dad that my mom's past premium has not been paid, but dad was current until the first of January. He plans on contacting his company on Monday to see if his premiums will be affected after that.

And you are so right....this is a clear indicator to move on.
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