State retiree health plan tries to screw us over

Miscellaneous and Personal Stuff I Must Share
1

I’m pretty hot at the moment.

I’m the husband of a State (I will keep them anonymous) retiree and, as a dependent, I’m covered under her Medicare PPO. Cost is minimal and coverage is excellent. (I think she had the length of service for it to be Tier 1.) About two weeks ago, I got a letter from the State Comptroller telling me that since I’m no longer a dependent, they were going to cancel all my coverage…Medicare PPO, dental, and prescriptions. It was basically a COBRA notification and they stated that it was effective 2/1/2026, almost a month prior to receiving the letter.

I won’t go into the bloody details, but my wife, who had actually been on the original State employees union team negotiating the contract and benefits, was not happy. She was on the phone with the State Comptroller’s office, the health insurance company, and the union rep within minutes. The Comptroller basically said, “Yeah, we reached out and you failed to let us know that he was still alive and married to you. Now you have to prove it.”

After several phone calls from both my wife and me, I’m covered again. Putting together the stories we heard, we deduced the following: The State hired a third-party “Medicare Part B Advisor” who promised to reduce their costs by paring non-dependents off the health plan. The company may or may not have sent letters to the retirees that required them to complete a form verifying their covered dependents are still alive and still dependents. My wife never received anything of the sort. Those retirees who failed to respond or failed to fill out the form correctly had their dependents’ coverage terminated immediately. The reasoning was apparently, “Well, if the dependents should still have coverage, they’ll get in touch and the insurance provider will re-enroll them.”

That’s right. The third-party company pretty much told the State that they could reduce their dependent insurance expenses by x%. They MIGHT have actually sent out letters to the retirees themselves, but I’m doubtful. Then they had the insurer remove a bunch of dependents without taking any further steps. It was all done and dusted before my wife and I even received any notification at all. My wife had to literally send a copy of a page of her IRS 1040 and an affidavit to prove we’re married and I’m still alive.

When I called this morning to verify that I’ve been re-enrolled and I’m covered, the insurer’s agent told me that she was very familiar with the situation and that they’ve been pretty busy dealing with the fallout.

I have no idea how much money the third-party company walked away with after their work, but I suspect it was based on the “savings” they created for the State.

2

I’m not a state employee, but, yup. That’s gotten common, contracting out a third party to verify dependents. I had to do that for the fist time last year.

3

We file our taxes separately and do not share any joint accounts. It’s pretty hard to prove someone is still alive and a dependent. Fortunately, we’re listed as each others’ spouses on our 1040s.

4

Not exactly the same, but somewhat related: My father died a few months ago, so my mother is supposed to receive survivor benefits from Social Security. But there’s a snag: Social Security says they have no proof my parents were married! They actually were married almost 70 years ago in a refugee camp in Austria (long story). They’d been filing joint tax returns for decades.

I think it’s straightened out now, but what a pain.

5

I got a letter from my former employer in November that in April I will have to provide evidence that I still alive in the form of a notarized signature. For me, getting to a commissioner for oaths (as they are called) is a major pain. Sounds like they are playing the same game only with my pension. Whenever an organization does something like this, I suspect someone in the administration is getting a kickback.

At some point McGill arranged for a customs broker to deal with all incoming packages. Suddenly our customs costs skyrocketed! A colleague got a book to review and was charged over $100 brokerage fee when previously books had always come in duty-free. We raised a real stink over that (including publicly asking what VP was getting a kickback) and they did drop it.

6

I have a contrasting story. A co-worker of my then wife said that her long time live in boyfriend was her legal spouse in order to get him health insurance. She had been lying about it for years.

7

This is a MPSIMS thread? You’d be fully justified in putting it into the pit.

I’m sorry for your distress and hassle and glad it seems like (?) your situation is going to be okay.

8

I knew someone that wouldn’t marry her long time boyfriend, at least in part, because it would raise her income above the threshold for getting insurance through the state, which at least at the time, was really good.

When we get cold calls from random insurance agents, one of the things they’ll promise is that they can lower our worker’s comp premiums. I can’t speak for other states, but at least in Wisconsin, the state sets worker’s comp premiums and they’re audited each year. I think a lot of business owners may not be aware of the fact that if an insurance company lowers your worker’s comp premiums, that state will simply bill you for the additional amount due at the end of the term when they do their annual audit.

9

I have a friend who somewhat hastily invited his partner to move in with him, so as to qualify the partner for dependant health insurance. (His company covers domestic partners, no marriage needed.) That was an ugly breakup about a year later.

I had to prove i was married to my husband before i started collecting my pension, but they were clear and upfront about it.

But losing benefits unexpectedly is scary, as well as a hassle. I once had my health insurance cancelled with no notice because “you no longer live in a covered area”. I hadn’t moved. The post office created a new zip code for my town and surrounding areas, and of course, it wasn’t on their list. There was no malice involved in my case (unlike @ZonexandScout 's) and HR did the work of getting it fixed, but i had no coverage for a month or two and that was pretty upsetting, even though we had no health issues at the time. Right now, with my husband taking a pill that costs as much as an iPhone ever day (cancer treatment) it would be devastating.

10

California passed a law allowing domestic partnerships and situations like that was one of the use cases but my anecdote preceded that.

11

I’m glad that the OP got it straightened out, but how many people did not do what it takes to shake the bushes and get coverage reinstated? How many just meekly said “oh well” and started paying COBRA premiums? What the state’s agent did was criminal and should have been prosecuted.

12

I recently had to prove my spouse is indeed married to me and eligible to be covered under my health insurance plan. Need the marriage certificate and another proof of relationship. But I could not find the marriage certificate, so had to print out a form, get it notorized, send in with a fee to the county we were married, pay for expedited delivery. All this stuff needed to be submitted by a deadline or her benefits would be cut-off by another date. Several nasty-grams reminding me to do this while we awaited delivery of the cert. And get this - I work for the health insurance company that our plan is with, and yep, the verification is thru a 3rd party. I guess they were promised some savings by scrubbing ineligible people, too.

@suranyi we had the same problem when my FIL died and had to jump thru a bunch of hoops so my MIL could receive survivor benefits. It took months to sort out, and luckily she was not dependent on that income during that time.

13

I basically feel the same way.

I don’t object so much to the State wanting to identify and remove non-existent dependents, or people who were once dependents (e.g., children who are no longer dependents), or dependents who have died. But the method they used to do this was the same way we used to figure out who was being serviced by a particular data switch in a building. We would turn it off and see who complains. That method worked great…until someone said, “Hey! These critical data monitoring systems haven’t been working for the last 30 days. We’re in violation of dozens of Federal and State laws.”

I have asked for a copy of the “dependent verification” letter(s) that were supposedly sent out by the third-party company. The response has been crickets.

14

I did not have too much trouble when my wife died. Lucky that.

But it was a surprise to me that in general, the Social Security Administration has no idea about anyone’s spouse or dependents. Despite getting info from the IRS every year about all that stuff.

The first time you’re even allowed to tell them who your spouse is, is after they’re dead or you’re claiming benefits off their record. Which means you’re needing paperwork that includes your deceased spouse, or your ex-spouse, or your current spouse. Two of those three are not going to be much help if you need their assistance to get that paperwork.

ISTM it’d be far better if one could record their marriages & kids with SSA in advance of them needing that info to act on.

So if there is any married USAian here with health problems, or a spouse with health problems, or where either of you are approaching retirement claiming age, take time now to ensure you have access to your marriage records. Both current and past marriages. It’ll save a lot of headaches when you’re already overburdened w lots of other issues.

15

My step-mom got ten copies of dad’s death certificate when he croaked and still ran out. They had a shit ton of bank and brokerage accounts though.

My ex-wife and I had “or” on everything mutual so it was easy. We each kept on car and sold them years later. I was a little surprised that I could drain our credit and savings account on my own. Since I knew her SSN, I was able to split the amounts and open new checking and savings accounts for myself and for her. Maybe it was because we were still legally married at the time.

16

This reminded me of something that happened when I was doing genealogy research many years ago. I hired someone to dig up what he could on my great grandfather and he came across his military record from the Civil War. That was pretty cool, but even better, his former wife had put in a claim for his military pension. She had no proof of marriage and had to write a history of their time together and have friends write affidavits attesting to the fact that they were married.

17

I wonder how long ago that’s been?

When I did my parents’ estates back in the late 90s and mid 2000s most places wanted originals but some did not. When I did my wife’s and MIL’s estates about 4 years ago now almost nobody wanted an original. The probate court did need an original which they kept. SSA wanted to look at an original, but they gave it back once they’d seen it.

Everybody else was totally happy with a color scan e-mailed or uploaded to them. A couple places were happy with a plain of B&W low res fax.

18

It was in 2017 but in fairness my stepmom is kinda whacky.

19

I was about to post almost exactly this. I got ten when my mom died, in 2021, and maybe i had to give one to the state? A couple of b&m banks wanted to look at an original, but handed it back. Every party that i dealt with online was happy with a color scan that i texted, emailed, or uploaded to their secure site. I still have a stack of death certificates somewhere.

20

That explains my stepmom’s situation. She can barely email let alone make a color scan or text a picture. She for sure needed extra copies