Texan frustrated with Medicare Savings Program application process

AUSTIN, Texas - When Elliott Fogel first emailed FOX 7 in March, he was still waiting on a Medicare Savings Program application that he had submitted for his father-in-law in December to move forward.

Using Medicaid funds, Medicare Savings Programs can cover out-of-pocket Medicare expenses like premiums or copayments.

"There was one piece of information that I put in last year, but it wasn't in there, and so I saved the application, and then I was going to look up this information, so I could enter it in there," said Fogel. "I got busy for like a week or so. I went back in, and I believe it was Dec. 15, and the renewal application gave me a message that it was canceled or something." 

Fogel said a day or two later he got a letter dated Dec. 14 that informed him it was too late to renew now. He said in past years, there were a couple of times he had completed the renewal close to or after the deadline, but it had never been a problem.

However, Fogel ended up having to start from scratch and re-apply.

Then, the waiting process began. 

"Another few weeks, maybe three weeks, go by, and I still haven't seen any progress on it. It hasn't even started. It’s not even in review. It’s just sitting there," said Fogel. "They said that there was just a big backlog."

Fogel detailed phone call after phone call attempt, and when they did finally get someone on the phone, there were multiple times new information was needed.

The application was finally under review in March and processed in April. They were told payments would start in June.

However, that meant for months, the payments had been coming out of his father-in-law’s Social Security. 

"I think he missed January, February, March and maybe April," said Fogel.

According to a spokesperson for Texas Health and Human Services, when a Medicare Savings Programs (MSP) application is processed, applicants are tested for eligibility for the month the application is received and for the three prior months. 

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Once the applicant has been determined eligible, Social Security will refund their Medicare Part B premium for each month of eligibility, though it may take up to 120 days for the refund to be received.

However, eligibility for the Qualified Medicare Beneficiary (QMB) program is effective on the first day of the month after an eligibility determination is completed. A person who is eligible for QMB will not be reimbursed for any Medicare premiums withheld prior to the effective date of eligibility. 

Fogel’s father-in-law is in the QMB program. 

"HHSC encourages all clients to respond to requests for information or case action and return recertification packets timely to minimize any potential delays in processing. Each request that requires action includes corresponding due date(s)," said James Rivera, press officer for Texas Human Health Services. "As of May 2024, the average number of days to process an Medicaid for the Elderly and People with Disabilities (MEPD) application was 78 days and the average number of days to process an MEPD redetermination was 60 days."

According to HHSC, as of May 31, there were 153,387 MEPD Community applications past federal processing timeframes, including MSP applications. Renewals do not follow a set processing timeframe but are processed based on review due dates.

"My main concern is how long it took…they knew right away there's a backlog so I know we're not the only ones," said Fogel. "I’m sure there are people that have had this happen to them that are in a worse financial situation than my father-in-law is, and I can't even imagine what the burden on them is as a result of things like this."

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