Medicare Prescription Drug Plan (MPDP) Opt-Out Update

Since writing the article “Medicare Prescription Drug Plan Fiasco – The Continuing Saga,” I’ve received over 40 emails and comments from site visitors experiencing the same issues; several are paying considerably more for their prescriptions under the MPDP plan. You can review all of the comments on our blog, they follow the article mentioned above.

This started last November, and many are still waiting for a resolution. We received letters from Social Security last Wednesday stating, “We will no longer deduct your prescription drug coverage income-relate monthly adjustment amount from your monthly benefit.” They are refunding the penalty and Part D premiums we paid in January this month.

Our Medicare online accounts also show that my wife and I do not have a Part D premium being deducted from our Social Security checks.

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What Caused the Problem?

From my discussions with multiple sources, GEHA enrolled all Medicare-eligible members in the MPDP program even though members initially had until early December to opt out of the program. This caused mass confusion for those wishing to remain with GEHA’s prescription drug coverage, and this triggered actions by Social Security and Medicare to enroll us in Part D.

Many of us filed appeals with Social Security and OPM’s OIG and contacted our representatives. Hopefully, this won’t create more issues as these entities go back and forth between OPM, Medicare, and Social Security.

Initial Contacts and Actions Taken

When I first became aware of the problem, I submitted an appeal to Social Security and, shortly thereafter, filed a complaint with OPM’s OIG. If your issue hasn’t been resolved, use the OIG’s online complaint form to file a complaint regarding fraud, waste, abuse, or mismanagement within OPM’s programs and operations.

The complaint form is the preferred method for submitting a complaint; however, you may also submit your complaint by calling the OPM OIG Hotline Number: 1-877-499-7295.

I also submitted this issue to my senator and Congressman. If you don’t need to register a complaint with them now, write down your representative’s contact information if you need assistance. We elected them, and they are one of our first lines of defense when we have an issue with a federal agency.

GEHA Response or Lack Thereof

My first call was to GEHA, and they forwarded me to one of their prescription drug customer service representatives. As I explained in my first article, they didn’t offer a resolution other than to call Silver Script again.

Medicare’s website showed that my wife and I were scheduled to pay a Medicare Part D premium through December 2025, and Social Security advised us that we had to pay a penalty plus late payment fees for Part D that we didn’t have.

After numerous calls to GEHA without resolution, I requested that GEHA’s public relations office set up an interview with the person responsible for their MPDP option and the opt-out process. They didn’t reply to my email request.

I made one final call to GEHA’s prescription drug customer service representative last week, and she was very helpful and empathetic. She has talked with hundreds in the same situation and assured me that all would be taken care of shortly.

Summary

I intended to write a follow-up article after my wife’s Social Security check arrives on the second Tuesday in February. Many people had asked for an update, so I thought it best to send one out as soon as possible.

It appears that our Part D premium has been canceled. We should know soon if they caught it in time for this February’s checks. Plus, Social Security has to send out a change notice since they notified us on January 3 and again on the 6^th that we were enrolled in Medicare Part D and they were withholding premiums and late penalties from our checks.

I really don’t know why mine got changed back to where it should have been from day one. We haven’t received feedback from any of those we contacted.

If your Medicare account still shows Social Security will be withholding Part D premiums, and you opted out of their MPDP program, you may wish to file a complaint with OPM’s OIG and go the same route I did. Possibly make one more call to GEHA; hopefully, you will reach the same very pleasant representative I talked with last week.

Many suggested moving to another provider during the next open season. I’m staying with GEHA, and as I stated in the previous article, they have provided exceptional healthcare services at reasonable costs over the past 11 years.

Hopefully, whoever was responsible for this fiasco is no longer with the company. Plus, most other FEHB providers already offer MPDPs; you may have the same issues if you change to another company next open season.

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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.

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Dennis Damp

Dennis V. Damp is an author, retired federal manager, business owner, career counselor and veteran. Damp is the author of 28 books, a recognized benefits expert, and a retired federal manager with 35 years’ service. Dennis has been a guest on hundreds of radio talk shows, CNN’s YOUR MONEY and the Lou Dobbs Cable TV shows, lectured at universities and colleges, produced Internet web sites and training videos, and has written hundreds of articles for national magazines and newspapers. His books have been featured in the Wall Street Journal, Washington Post, New York Times and U.S. News & World Report.

Dennis joined the Air Force in 1968 and spent over three years on active duty and an additional seven years with the Air National Guard. He was hired by the Department of Defense (DOD) after leaving active duty and transferred to the Federal Aviation Administration (FAA) in 1975. He spent the remainder of his career in various positions with the FAA. His last position was technical operations manager at the Pittsburgh International Airport’s air traffic control tower.

GEHA Opt-Out, IRMAA, Medicare Part D, MPDP, MPDP Opt Out, Part D Penalities

3 Comments

Emma February 18, 2025 at 7:28 pm

I am still working through this mess. Currently I have no drug plan at all. Silverscript detached me from Caremark, but GEHA did not re-attach. I have now been on hold 6 hours with GEHA per their customer service to re-enroll in the drug plan. It’s not automatic. Meanwhile Medicare and IRRMA have hit to the tune of $80 per month plus a mysterious $157 one time fee. I’m not dealing with Medicare until I’m back with GEHA. I stopped buying prescriptions on January 1 because my most expensive drug went from $10 / month to a whopping $500 / month. That cap means nothing because it excludes so many things. PS: I noticed that GEHA no longer has Customer Service Reps; they are not “Advocates” – perhaps a more honest name as the Advocate on behalf of GEHA. Yes, this was messy but where was OPM in all of this?

Juanita February 17, 2025 at 5:30 pm

Were you a federal employee or postal? I was told when I first called that since I was postal, I could opt out, now I’m being told that only non-postal people can opt out. Well, you CAN opt out, but then you have nothing, since it does not go back to the way it was, contrary to what I was told.

Has anyone come up with any other way to get prescription drug coverage?

I still think GEHA should lower our monthly premium, since they are opting out of most of our expenses. Huh, fat chance!

Nancy February 8, 2025 at 3:43 pm

We finally got out of SilverScript but then we had nothing. So many phone calls to GEHA and finally, Lucinda, God bless Lucinda, cared about our predicament. She sent an urgent request to re-enroll us in GEHA CVS Caremark and even called me the next day to give me an update. I have also written to OPM, congressman and senators.

Dec 31, 2024 GEHA laid off 400+ employees at the same time they rolled out an entirely new website. You probably already know this but I did not. I just read in 2021 they bought the naming rights to Kansas City football stadium and are paying Patrick Mahomes, a 2024 SuperBowl football star, to promote them. No telling what else? More ads, less service. They serve federal employees, not the general public, why all this advertising?

Thank you for keeping us updated.

Comments are closed.