Posted on Friday, 10th January 2025 by

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Christmas came early for those subject to the WEP and GPO provisions but not for those who opted out of GEHA’s MPDP plan. Many, including my wife and me, opted out of Silver Script’s Part D (EGWP) Medicare Part D Prescription Drug plan offered by GEHA in late November, and we received a confirmation letter from them dated 11/28/2024.

EGWPs, or Employer Group Waiver Plans, are Medicare Advantage plans offered by employers or unions to retirees. Private insurance companies manage these plans and are often exempt from specific rules that apply to individual Medicare Advantage. This applies to the MPDP option.

We stayed with GEHA’s standard plan, and after opting out of their MPDP plan, we assumed all was well and that our prescription drug coverage would continue to be covered by GEHA, not Medicare Part D.

Who’s on First and What’s on Second

This subtitle is from Abbott and Lou Costello’s hilarious comedy routine. The head doesn’t know what the foot is doing, and one group passes the blame to the other. We discovered mid-December that we were enrolled in Part D, and the opt-out process failed! The situation has been back-and-forth for over a month without resolution.

We received three sets of GEHA medical and dental cards and a set of Silver Script Medicare Rx cards at various times over the past six weeks. The most recent GEHA set arrived yesterday.

One contradicted the other, and Silver Script, when first contacted, said that GEHA inadvertently enrolled all members in the Silver Script plan. I don’t know if this is true; I only know that members have suffered the consequences of their incompetence, whoever it may be.

I’ve talked with Social Security, Medicare, Silver Script, and GEHA and tried to contact OPM unsuccessfully. Each time I’ve called OPM over the past few weeks, their recording states, “We are experiencing very high call volume. Please call back later.”

Battling With the Giants

I visited the Medicare site after Silver Script advised us the second time that we were not enrolled in their program. Our Medicare site page showed that we were enrolled in Parts A, B, and D with GEHA, and the UMR insurance company identified as secondary providers. No one, including Medicare or GEHA, could tell me why UMR was listed as a secondary provider or what services they covered; we never signed up with UMR.

This was especially upsetting, considering GEHA implemented the MDPD option without asking members if they wanted to enroll in a Medicare Part D prescription drug program at an additional cost for many. Instead, they asked members to opt out, and the opt out process isn’t functioning properly.

After contacting GEHA several times about these issues, I couldn’t get anyone to understand the gravity of the situation or take actions to correct it.

Silver Script, after contacting them for the third time, assigned another task number to research the issue again. A week later, Medicare Part D was removed from our online Medicare accounts. However, when we went to our online Medicare payment details, they showed us paying a Part D IRMMA through December 2025.

Medicare customer service suggested we contact Social Security immediately because IRMAAs were scheduled to be deducted from our checks for the entire year.

The Last Straw

My wife and I received Retirement and Disability Insurance letters from Social Security on January 6th advising us that they were deducting past-due Part D prescription drug coverage income-related monthly adjustment amounts from our Social Security checks and a penalty for past-due Part D premiums! Our Social Security checks are being reduced by a Part D IRMAA plus additional penalties for late Part D payments!

I immediately called Social Security as Medicare suggested and was on hold for over an hour until the line died. The next morning, I called again and waited on hold for over two hours.

After discussing the issue with the specialist, she stated she could do nothing. Our only option was to file an appeal for each of us, including documentation to support that we had not enrolled in a Part D Plan and why we should not have to pay a late penalty.

I spent several hours writing the appeal and had to convert the opt-out letters we received confirming that we opted out of the Silver Script EGWP plan to a PDF file. Later that afternoon, I submitted the appeal online with attachments. You can also submit it via regular mail with copies of your documentation.

Conclusion

Several newsletter subscribers have experienced similar problems and are still unsure if it is resolved. According to one of Social Security’s support specialists, a typical appeal can take several months to over a year to work its way through their system.

My wife and I will pay monthly Part D premiums and an additional penalty for some time even though we aren’t enrolled in Part D. They assured me these payments would be refunded if the appeal was settled in our favor.

Silver Script confirmed again that we were not in their system and to use the GEHA cards we received. The card with CVS Caremark listed at the lower right corner of the card, and UnitedHealthcare Choice Plus Network is directly below the CVS designation.

I called GEHA’s CVS Caremark prescription drug services today and talked with Rhonda. I said, “Help me, Ronda.” Her name reminded me of that song from the 1960s,” and she did. She was helpful, pleasant, and confirmed that I was in their system.

I’ve always commended GEHA for its excellent service, customer support, and reasonable rates. Since signing up for Medicare ten years ago, my wife and I haven’t paid any out-of-pocket costs except for prescription drugs.

GEHA’s and Silver Script’s lack of attention to detail was disappointing when they rolled out this new MPDP program. The administrator for this rollout didn’t realize the disruption it could cause if mishandled or that members who opted out are now paying IRMAAs. Their Social Security checks are less than last year! This could go on for many months.

I intend to stay with GEHA and hope this is simply a one-off, not indicative of the company’s current state of affairs. They have served my wife and me well over the years.

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Disclaimer: The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, investment, and benefit information are subject to change. To ensure the accuracy of this information, contact relevant parties for assistance including OPM’s retirement center.

Over time, various dynamic economic factors relied upon as a basis for this article may change. The information contained herein should not be considered investment advice and may not be suitable for your situation. This service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Last 5 posts by Dennis Damp

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Posted in ANNUITIES / ELIGIBILITY, BENEFITS / INSURANCE, ESTATE PLANNING, FINANCE / TIP, RETIREMENT CONCERNS, SOCIAL SECURITY / MEDICARE, SURVIVOR INFORMATION | Comments (2)


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2 Responses to “Medicare Prescription Drug Plan Fiasco – The Continuing Saga”

  1. Nancy P Says:
    January 11th, 2025 at 8:32 pm

    Wow, Dennis, we are going through the exact same thing. Down to 3 sets of GEHA cards and Silverscript cards.

    A very nice lady I talked to at Silverscript said she did an online form for me stating I have not had a lapse in a drug plan, but I don’t feel trusting. I sent a certified return signature express priority letter to Medicare/Silverscript showing I have had a drug plan since I retired in 2018. Also I faxed letters to Silverscript opting out *for the 3rd time*.

    GEHA was very reassuring that we are in the GEHA medical plan with the drug plan and we are not enrolled in Silverscript. But the Medicare.com says we are indeed. Medicare.com also lists the UMR.com.

    I did have a new prescription filled at Costco with my new GEHA card without any trouble and that transaction is reflected on the GEHA site under the pharmacy tab. So, it seems we have our prior GEHA plan in place.

    Yesterday, I was tallying up how much we spent at the dentist the last year and how much our GEHA Dental insurance paid. Well, I can’t see my husband’s information. It seems he has to sign into UMR.com and give me permission to see his information. I am not signing up into anything else until this is straightened out. This is the first year we don’t have the IRMMA payment for Medicare, so that is one less problem, I can’t imagine getting a refund from Social Security.

    This is infuriating. GEHA says we do not have Silverscript and do have our old plan in place and Siverscript is positive about the opposite.

    My Dr’s office was really puzzled about all new numbers for our GEHA account and I wonder if their new website and new everything is contributing to this. Three sets of cards is very disorganized. We have not had problems with GEHA in the past, I was with them before I retired.

    I am going to email our US senator and get them informed now. I worked as a nurse at the VA for 37 years and often encouraged vets to contact their congressmen/persons/people for assistance with their snafus, I even handed out their names and contact information. Today I thought I should take my own advice.

    Good luck to us all and thank you so much for your guidance.

  2. Dennis Damp Says:
    January 12th, 2025 at 7:52 am

    I received many emails from others who are experiencing the same issue, including Blue Cross Blue Shield members; it isn’t limited to GEHA. I’ll know exactly how bad this is when we receive our February SS checks. The first month, the reduced payments, including penalties, are supposed to be deducted from our Social Security checks. I, too, suggest everyone experiencing this issue should contact their congressman, which is a very good idea since this is apparently a systemic problem that has been going on since the MPDPs were first offered by FEHB providers. I hope these problems are resolved timely for everyone, but I feel this could drag on for months.

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