From: John Bozinny
Date: 1/5/2015 6:17:55 PM
Subject: Med Insurance
Mark,
Thought some of your readers may be interest in the following
information.
Potential
Help When Medicare Advantage Drops Doctors
The Centers for Medicare & Medicaid Services (CMS) has announced it will offer in 2015 some Medicare Advantage participants an opportunity to leave their health care insurance plans if a “significant” number of doctors or other health care providers drop out of their Medicare Advantage plan.
CMS will make a “case-by-case” determination based on the number of beneficiaries affected and whether they received adequate and timely advance notice, the size of the plan’s service area, when during the year the provider terminations occur and other factors. Once CMS decides that a Medicare Advantage plan’s members should be allowed to leave their plan, the agency will require the plan to notify its members about their new options.
CMS will create a special three-month enrollment period following network changes “considered significant based on the [effect] or potential to affect, current plan enrollees,” according to an update to Medicare’s Managed Care Manual. During that time, they could join traditional Medicare or another Medicare Advantage plan whose provider network includes their doctors.
Only CMS will make a determination of the need for this provision. Individual beneficiaries who are concerned after their doctor is dropped from a Medicare Advantage plan cannot request the special enrollment period.
The special enrollment option comes after CMS established stricter notification rules for Medicare Advantage network changes that also take effect Jan. 1, 2015. Insurers must tell CMS at least 90 days before instituting network “significant” changes. The rules also recommend that insurers provide more than the required 30 days’ advance notice to beneficiaries. It should include the name of the provider being terminated and how members can request continuation of ongoing medical treatment from that provider.
Bill Kadereit, President
National Retiree Legislative Network
The Centers for Medicare & Medicaid Services (CMS) has announced it will offer in 2015 some Medicare Advantage participants an opportunity to leave their health care insurance plans if a “significant” number of doctors or other health care providers drop out of their Medicare Advantage plan.
CMS will make a “case-by-case” determination based on the number of beneficiaries affected and whether they received adequate and timely advance notice, the size of the plan’s service area, when during the year the provider terminations occur and other factors. Once CMS decides that a Medicare Advantage plan’s members should be allowed to leave their plan, the agency will require the plan to notify its members about their new options.
CMS will create a special three-month enrollment period following network changes “considered significant based on the [effect] or potential to affect, current plan enrollees,” according to an update to Medicare’s Managed Care Manual. During that time, they could join traditional Medicare or another Medicare Advantage plan whose provider network includes their doctors.
Only CMS will make a determination of the need for this provision. Individual beneficiaries who are concerned after their doctor is dropped from a Medicare Advantage plan cannot request the special enrollment period.
The special enrollment option comes after CMS established stricter notification rules for Medicare Advantage network changes that also take effect Jan. 1, 2015. Insurers must tell CMS at least 90 days before instituting network “significant” changes. The rules also recommend that insurers provide more than the required 30 days’ advance notice to beneficiaries. It should include the name of the provider being terminated and how members can request continuation of ongoing medical treatment from that provider.
Bill Kadereit, President
National Retiree Legislative Network
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