Is Reinstating a Part D Plan Possible?

Posted by Wise Medicare
Estimated Reading Time 2 minutes 16 seconds

What would you do if you learned your prescription drug plan was cancelled without knowing there had been an issue requiring your attention?

Too often, consumers in this situation are left communicating desperately with representatives from their insurance company whose unwavering position on the matter lacks any hint of empathy.  In most cases, issues of non-payment boil down to incorrect mailing addresses on file or poor communication between the parties – not consumer intent to evade their responsibilities.

The real issue, however, is how to resolve and reinstate a policy for consumers when most doors appear to be closed given the limited enrollment periods Medicare makes available.

This is where having a Medicare professional – like our team at Wise Medicare – available to review the unique details of your case becomes ever more important.  Take Sara’s situation for instance – a recent case our team helped to resolve.

When Sara went to her local pharmacy in March to pick up a monthly prescription, she was informed her prescription drug plan was canceled, therefore denying coverage of the medications she required. She and her husband immediately reached out to their insurance carrier who informed them that they had not paid their premium for three months resulting in the automatic cancelation of their policy.

During the call, Sara’s husband learned that the mailing address on file was incorrect, which is why they never received correspondence regarding the lapse in premium payments, nor the billing invoices that had been sent to them. He asked the representative to update the mailing address on file to the correct PO Box and paid all back-dated premiums.  Unfortunately, the insurance company still refused to reinstate the policy.

Sara was now without prescription drug coverage for the remainder of the year – a costly dilemma in which Sara would begin incurring monthly penalties that would apply for the lifetime of her future Part D prescription drug plan premiums; not to mention having to pay full cost for all her medication needs.

Sara and her husband stopped by Wise Medicare for assistance in May. During the consultation, it was learned that the pharmacy was responsible for establishing the Part D plan with the insurance company and had accidentally provided the incorrect mailing address during the process.

In the weeks that followed, our team took the time necessary to advocate on Sara’s behalf with the insurance company and Medicare directly, providing information and facts required to reach a satisfactory outcome. As a result, Medicare processed Sara’s complaint at our request and assisted her in submitting a new Part D application with the insurance company under a special election period they determined to be appropriate.

In June, Sara learned her prescription drug plan would be reinstated July 1 without penalty for the lapse in time.  An outcome we all found ourselves celebrating.

Although not every scenario will end the same, it exemplifies that even the impossible can be achieved when you have the right professionals by your side.  Knowing how to communicate, what to look for, and who to raise your concerns with is why our team at Wise Medicare is so passionate about working for the community.  We make every effort possible to stand up for what is right and identify solutions when none seem possible.