Report: #1071171


  • Submitted: Mon, July 29, 2013
  • Updated: Mon, July 29, 2013
  • Reported By: hgasel — newport North Carolina

    HOT SPRINGS, Arizona


*UPDATE Employee ..inside information: Coverage Gap

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AARP UNITED HEALTH CARE IS QUITE THE CON ARTIST OF COMPANIES--when signing up for new part d insurance i ensured i would not go into the coverage gap and that the cost of the meds were indeed lower than the company i was with and both AARP & MEDICARE ensured me this was the case.  So April and May the prices they gave me were correct. Well come June i was being charged 15% instead of the company co-pay which was cheaper and when i called I was told by AARP that i was in coverage Gap---well i fought and argued with them and medicare to prove i was not subject to coverage gap--aarp website an explanation of benefits paperwork deliverd by mail to my house all show i was in initial cover and was not subject to coverage gap because i receive extra help--they kept ensuring me the website and the EOB was wrong and i was subject to coverage gap---so finally after about 20 calls total between AARP and MEDICARE they finally admit I am right I am not subject to coverage gap HOWEVER A VERY BIG HOWEVER---that even though i am not in the coverage gap the amount of money i have reached would TECHNICALLY PUT ME IN THE COVERAGE GAP---so they are putting me in "AN INVISIBLE COVERAGE GAP" **(the words of AARP CSR) not mineso they are going to charge me 15% not the co-pay and i should feel lucky that they only cahrge me the 15% and not the regular 78% or whatever it is they charge for people who ACTUALLY ENTER THE COVERAGE GAP---so thinking this is absolutely absurd i call medicare and tell them about this "INVISBLE COVERAGE GAP" the medicare CSR assured me this isnt true--until she checked into it for about 30 minutes and to both our surprise IT IS COMPLETELY LEGIT---they lured me in and now they got me---dont go with AARP unless you hear all the facts!!!!!! I am still young and am able to read and understand things i just feel bad for all the old people in this predicament and cant understand all the coverage gap and invisble coverage gap---


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This report was posted on Ripoff Report on 07/29/2013 07:47 PM and is a permanent record located here: The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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#1 UPDATE Employee ..inside information

Coverage Gap

AUTHOR: Donna - ()

First, having the Enhanced RX plan does not prevent anyone from going into the coverage gap and if the person who enrolled you told you that and you have their name, you should file a complaint with Medicare. If you don't have their name call the plan's customer service line and tell them you want to file a complaint against the individual who enrolled you, as they would have a record of who enrolled you if you enrolled by telephone. The Enhanced plan merely continues to cover certain drugs while you are in the gap. This information would be in the Evidence of Coverage booklet you should have received after enrolling.

With your "extra help", which is a low income subsidy from Social Security, you pay 15% of the cost of your medications or the plan copay, whichever is less, during your initial coverage stage. When the total cost of your drugs exceeds $2,970 during the calendar year (this is what both you and the insurance have paid together so is the actual cost of your meds) you are in the coverage gap. While in the coverage gap, with your subsidy, you pay a flat 15% of the cost of your drugs. So you do have coverage even though you are in the gap, but only because you have extra help. You may also want to look into changing your plan to the Preferred plan as part of your monthly premiums are being paid by Social Security and that plan is much cheaper. Because of your extra help, you can do this at any time. You can also call Medicare and ask them to find the best plan for you by giving them a list of the medications you currently take.

Also keep in mind that the EOBs you receive are always one month behind so the amounts are never up to date but merely a record of what was spent in the previous month.

I do understand your confusion, as the Part D plan, which the Bush Administration started, was I believe intentionally written so as to be as difficult to understand as possible. As you found, even employees of Medicare misinterpret many of the regulations of the plan.



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