All,

Forwarding an update from CMS on MPF and OEP. 

 

Ann

 

From: Kinney, Rebecca (ACL) <xxxxxx@ACL.HHS.GOV>
Sent: Tuesday, October 27, 2020 10:15 AM
To: xxxxxx@LIST.NIH.GOV
Subject: OEP/MPF Update from CMS

 

Caution. This email is EXTERNAL.

Hello Everyone,

 

CMS has provided the following updates and information regarding Medicare Open Enrollment that address outstanding questions we’ve shared with them.  As a reminder, this information should be shared with your teams but is not intended for public distribution.

 

First off thank you for following the new inquiry process.  It’s resulted in quick escalation and resolution of issues.   We encourage you to keep following the protocol because it’s working well.

 

General State of Operations

·         After the first week of Open Enrollment, Medicare Plan Finder online shopping is up, and enrollments are up.  Call center operations are progressing as expected, with the number of calls and topics staying in line with our projections. We have seen an increase in Web chat traffic over last year, which may be a result of more people doing things online this year due to COVID.

·         So far, 1-800 MEDICARE has received about 1,000 calls to the dedicated SHIP line, which is consistent with last year. Wait times for these have averaged less than 5 minutes with a few outliers. 

Low-Income Subsidy (LIS) Display

·         There was confusion over the display of some beneficiaries’ future low-income subsidy status.  The call center was able to quickly verify that future statuses were correct, and pulled specific examples to show how a display issue with beneficiaries who receive extra help as a result of applying at SSA, was causing confusion. Our teams were also able to verify that the plan pricing information still reflected the correct LIS pricing and the issue was limited to the display only.  The display issue was resolved on Monday, 10/19.

·         Another LIS update was made on 10/23 that addressed the display of the drug deductible for beneficiaries with partial LIS. For these beneficiaries it was showing a higher cost than they might pay.  This issue was resolved on 10/23.

In-Network and Out-of-Network Pharmacy Pricing Displaying N/A

·         As previously reported, if you see “N/A” on a plan card in the Medicare Plan Finder instead of pricing information, it means that the plan has an error with their drug pricing data and in accordance with normal protocol, Medicare has temporarily removed the information.  This isn’t a bug or problem with the Plan Finder, but is an issue with the data that the plan provided to CMS. You should see updates that resolved the Cigna-HealthSpring plans (including the limited Express Scripts Plans impacted) yesterday, 10/26.

Insulin Savings Plans

·         There have been many problems reported that are really just confusion over how the Insulin Savings Plans work.  These are not Plan Finder issues.  Medicare’s Senior Savings model sets a maximum copayment of $35 for a 30-day supply of certain insulin drugs. Participating plans can choose from a list of insulin drugs for this model and decide which insulin drug they will offer for a $35 copayment. Plans can change those options at any time during the year and typically don’t offer all insulin drugs on the list for a discounted copayment.

·         Beneficiaries who receive Extra Help aren’t eligible for these discounted insulin copayments because they already have a lower set copayment for their covered prescription drugs.

·         Depending on the insulin and other prescription drugs that a beneficiary needs, it’s important to remember that there may be plans that don’t participate in this model that could offer lower yearly drug + premium costs. Be sure to consider the total yearly drug cost for ALL available plans, and explain all the options to the beneficiary.

Special Enrollment Period

·         A few Inquiries have been made about granting a Special Enrollment Period.  As in previous years, after Open Enrollment has ended, if a Medicare beneficiary believes they have a circumstance where an SEP is warranted they should call 1-800-Medicare and explain their situation.

Please continue to follow the protocol and to alert us when come across issues that appear widespread.   We will continue to provide updates as we receive them from CMS.

 

Good luck with the remainder of OEP!

 

Best,

 

Rebecca M Kinney

Director, Office of Healthcare Information and Counseling

Administration for Community Living

U.S. Department of Health and Human Services

Office: (202) 795-7375

xxxxxx@acl.hhs.gov

 

 

 

 

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