Can an individual be reimbursed for the premiums they paid to a supplemental insurance carrier when they were not needed?

No, I don't believe there will be any refund of premium. She should be using her medicare and medicaid for her health care, she should also have a drug plan unless she has an advantage plan that shows "Dual Need" status.

MaggieJ, you were lucky. My husband worked for GM. UAWs took over the benefits. Every year we get a letter explaining my husband's benefits and who is covered under them. We contact them with any changes.

Ahhh now I see what you were referring to. It reflected "at home" (which meant her home) not "at my home" which was another option.

Yes something is definitely wrong -I did not place that on my profile, my mother does not live with me. Haven't lived with my mother since I was 18!

NikkiP: Something is definitely amiss here. Your profile says that your mother lives with you. Then you say she lives in public housing, presumably "Section 8?" Please clarify.

Thank you all! Fortunately, mom is extremely healthy and requires no prescriptions, monthly doctor visits, etc. She did go to an Urgent Care facility a few months ago for an ear infection (oh and was billed, and paid $88 so something was definitely wrong! My guess is she did not provide all of her cards) but prior to that, her last medical procedure was about 8 years ago. Very long story short, I agree with the majority and it is not worth pursuing. If she were to be reimbursed, it would not only impact her resource limit but also quite possibly her rent. She lives in public housing and her rent is based on her (minimal!!) social security income minus her insurance co-pays and maybe 1 or 2 other factors. Live and learn…sometimes a very expensive lesson!!

Harpcat: Your point of tax implications was a secondary thought, but nonetheless a good one. If you itemize, you must reach 10 % above AGI to be able to qualify for medical. In regard to the OP's question, she should show up at the insurance office with attorney (if at all possible). You may have a better chance to get refunded past premiums that way.

Nikki, if you're still around 6 days later, I believe it would be considered that your mother initiated and continued the BCBS coverage of her own free will, that she was not coerced, and could have realized she didn't need it by doing some research.

This is not a criticism, just the factual way it would be viewed.

It's incumbent on each of us to do the necessary research and make our own decisions as to whether to carry supplement or gap insurance.

And in my experience, if premiums aren't paid after I believe it's 2 months, BCBS stops coverage; in any event, it wouldn't pay for any of its portion of costs incurred during that period.

That raises another issue; BCBS could state that, if it did pay anything during the period of coverage, it would have the right to recover those payments.

This is a sad situation, and it's kind of you to share it; people can always see this a situation that they should avoid.

One note, is that if you itemize your mother's deductions at tax time...the premiums are tax deductible. I agree...she contracted insurance in case she needed it. It is not the insurance company's fault that she didn't use it. Cancel if it's no longer needed.

When I applied for Medicare the person at the Social Security assigned me a SHINE councilor. The person is suppose to help you navigate the Medical system. I would find out who your Shine councilor is and let that person find the answer to your question,

She is or you are gong to have to look at the policy in detail to see if you can opt out with no penalty and try to obtain a refund for what was paid into it already. I would think there be a time clause on receiving any monies back, though.

My father-in-law retired and his medical insurance premiums were being deducted from his pension. He had difficulty understanding business/medical terminology and after approximately 15 years, told me his insurance had been cancelled. I poked around, discovered that not only was his insurance still in effect, but he had also been paying premiums for his deceased wife. I contacted the insurance. Per their request I provided a death certificate and explanatory letter. He received a huge refund for over 10 years of premiums on his wife. It never hurts to contact the insurance company. Different circumstances will have different answers.

Bluebonnets, the explanation of medicare and Medicaid was not needed here, as nikkiP looks like she already knows about that from the question she posed…
Nikkip looks like she knows she paid for the medigap i.e. the supplemental insurance policy. Nikki has fallen into the same situation as I did…my mother has medicare, Medicaid and was also paying for a supplement to medicare which mom has AARP. I myself didn’t know that if mom has Medicaid it could now be the supplement to medicare and the AARP supplemental (medigap) was not needed all this time. So mom was over insured. So all my mother needed was medicare and Medicaid. Right now I am still choosing to keep her on all 3 and really only using medicare and AARP supplemental, because of where I live there really is no doctor who will take Medicaid, it would severely limit her choices in all her specialties mom needs, of course I am learning that AARP amounts are so little that it would actually behoove us to drop the AARP and pay out of pocket, because mom’s premiums are 267.00/month, it would be cheaper to pay out of pocket (OOP) than keeping the supplemental. I keep it because mom is 91 and I worry if she were to be hospitalized for days, that’s when AARP would help us, and really only for that reason. In answer to NikkiP’s question though, it would look like it is “on her” that she continued to pay for BCBS, because her mother was still covered and insured for that time and could use the policy as needed and probably did use the insurance during those years, so to me, she could definitely NOT recoup those premiums for those 12 yrs. Just going forward, cancel BCBS and use Medicaid, but just know, in my experience, depending on where you live, it will limit your options of doctors. ~If you’re okay with that.

When my aunt went into a nursing home she finally ran out of money and had to go on Medicade I continued to pay her supplemental insurance. She was given a special low rate for RX policy. She was able to keep $40.00 a month and under $2000.00 in checking account. Medicade paid nursing home bill after her account gave them what was left of SS monthly. This is in Ohio. I wouldn't dream of not paying her premium. It saved the state her medical bills. In the end she could only keep 40.00 anyway. I'm just greatful that she was cared for. Absolutely no complaints.

Nikki - my mom had BCBS as her secondary to Medicare for years; when she went onto NH Medicaid, she had BCBS policy "suspended" with payback of premiums paid for the 6 mo period she was "Medicaid Pending". BCBS like most insurers will not pay for services IF there is another insurer who can be billed either as primary or secondary. Medicaid & Medicare are primary or secondary insurers depending on what the ICD-10 code is.

There was an upside & a downside with this at least for my mom.

Her BCBS was high option federal (policy through my deceased dad) w/premiums taken from federal annuity automatically each mo. Premium was very low (a federal perk!). TX Medicaid pending took almost 6 mos to process, so during that period many services provided at NH & an ER visit were billed to & paid by BCBS. Once she became Medicaid eligible, BCBS can either become "suspended" or cancelled. Mom did suspension. So this made her Medicaid required co-pay or SOC (share of cost) of income paid each month to the NH higher once the suspension in place at month 6. Now in speaking with her caseworker at month 4 or 5 on a snafu on her life insurance policy clarification, he told me to try to make it so that the month she got the 6 mo premium $ back to have her assets under 2K with the added in premium $, otherwise she'd be over Medicaid asset limit & it would need to be reported. The back pay premium was NOT owed to NH as long as her overall financial eligibility was within Medicaid limits. $ back was just a few hundred.

But one problem that arose and went on for months & month & months was that vendors who were paid by BCBS had their payments clawed back. Or if they continued to bill BCBS had their invoices rejected. If they wanted to be paid, they had to rebill to Medicaid. Medicaid pays lots, lots LOTS less than BCBS. I sent a certified letter to NH on the BCBS suspension at month 6 when filed & received by BCBS. NH as they - via the medical director or DON - contact & contract vendors have the responsibility to let them know. Long story short…vendors not happy. Couple did NOT participate in Medicaid, so no rebilling done but payment claw backed. Clawbacks do not happen quickly plus many vendors have so much billing back & forth not noticed right away. One PT billed my mom at month 9; others well over a year later. Problem is that if they are on NH Medicaid, they have no real $ to pay bills in full. One of the PT's was willing to be paid partially discounted from the BCBS premium overage. Another just wouldn't & went off at a care plan meeting on this & not happy with either myself or NH (as NH DON didn't tell vendors). Another sent bills for over 2 years & again would not take partial payments.

My point is that IF your mom had any services paid by BCBS for all those years and you/mom file to get all that $ paid to BCBS, BCBS will clawback and vendors can bill your mom or if you signed off to be financial responsible for her seek you out to get paid; file collection.

Also if your mom were to get all those years(?) of payments back, it probably would not be smallish $ like my mom's was. But have a comma in it - 1 year alone is $ 2,100 much less 10 or 12 years!!! - so your mom would be ineligible for Medicaid, possibly for months and a whole stack of paperwork to wade through plus probably have to reimburse the state for care provided or do a spend-down. 10 years = $ 21,000.

Let it be. She & you totally own the error, you all's mistake. Doing anything now becomes a total clusterF of problems imo.

No, it's not likely at all you will get back a single cent.
Dad bought a LTC policy for mother, so she would not have to be a burden to us kids ( as he felt he was). It will never be used and we know we can't get back the cost of the policy. It's like buying car insurance and you don't drive. Ins companies don't care--if you bought the policy, you "HOPE" you won't need it, but it's insurance against the unforeseeable. Because you didn't need it, or use it, that's great for them. It's like a bet: You bet you'll need the insurance, and the ins co bets you won't. They win, always. Why are they so huge and make so much money?? You can try, but, don't have any hopes hinged on getting anything back.

Was ur Mom given Medicare because of a disability before 65? If so then this is why she is receiving Medicaid. If she received Medicaid after 65 then she applied for it and should have dropped her other insurance at the time she qualified. You cannot blame the insurance company. Somehow they found out ur Mom was now on Medicaid and did send a notice. It was up to ur Mom or her representative to cancel this policy. The blame is not the insurance companys.

I'm sorry to say NikkiP in My opinion Your Mom would have a far greater chance of finding the crock of gold at the End of the Rainbow.
Insurance Companies do not entertain reimbursements.

I had the same thoughts as Countrymouse when I read this post 5 days ago, the only possibility to get any refund would be to prove that the insurance agent knowingly sold a policy that was not needed. I expect that would be very difficult, if not impossible, to prove, especially after 12 years have passed. Caveat emptor.

You must be on top of these insurance companies, they will get every penny out of you that they can. It's very sad.

I'm not sure if it would be applicable here; but in the US have you had the same kind of scandal and backlash against "mis-selling" of financial products that we've had in the UK? I'm just wondering if NikkiP's mother might make some headway if she were able to establish that the insurer was at fault for selling her a product that was inappropriate for her.

I spoke with a social worker at Tricare and she said it was the patient's responsibility to know their options and a person can always purchase another type of insurance policy.

Like most of us, you seem to be confused about Medicaid and Medicare. Medicaid is for people who need medical (including nursing home) assistance due to few "countable" assets (which do not include the home) and low income. Medicare is for disabled people and people 65 and up. It comes in two flavors: Medicare Advantage (formerly called, "Medicare Choice") and traditional Medicare. Traditional Medicare includes hospital coverage (Part A), out of hospital coverage (Part B), prescription drugs (Part D) and the opportunity to buy supplemental or "Medigap" coverage. There are about a dozen forms of this. Perhaps your mother's BCBS supplemental insurance is her Medigap policy.

In any event, the likelihood of an insurance policy returning premiums because the insured later discovered that she was over-insured is slim to nil. She bought the insurance and the insurance company insured her, whether or not she ever applied for benefits.

My mom was entitled to Tricare for decades and I never heard of it and she fell through the cracks and was never added to it -- I had a horrific time getting her on it but I did it -- this represents tens of thousands of dollars in losses including co-pays for surgery and doctor visits she could have saved on. Entitled for reimbursement? FORGET IT.

I'm not a lawyer, but will relate my negative experience relating to hospital bills. I made monthly payments toward my husband's hospital bills while he was alive and after he died. When I phoned the hospital's billing department to ask if I could pay less per month on his bills I was told that I owed nothing because when he was hospitalized he had signed that he alone was responsible for his bills. When I asked whether I could recover the amount I paid toward his bill, I was told that I "had paid of my own free will," and could not be reimbursed. You can try for reimbursement of premiums for your mother, but be prepared to be told about "free will."