Medicare Flashes

Be Fit and Defined Dental Benefit Denial Letters

January 24, 2017

Some members are receiving denial letters for reimbursements above Be Fit’s allowed amount of $30 per month or their $200 or more defined dental benefit.

If members send us receipts for reimbursement that exceed these allowed amounts without a form or noting the allowed amount they expect to receive, they will receive a check for the allowed amount and a denial letter for the difference.

If members acknowledge that they’re aware of these allowed amounts, they will not receive a denial letter. For Be Fit reimbursement, they can do this by:

or

  • Noting “For $30 only” on their receipt for gym membership or fitness classes

For defined dental benefit reimbursement, they can do this by:

  • Noting on the receipt that it’s for the amount of their plan’s defined benefit only

In some cases, they will receive a denial letter before the reimbursement check because denial letters are sent out immediately after the reimbursement is processed, but checks for reimbursements are only sent once a week. They will also receive Explanations of Benefits (EOBs) showing the details of what was paid and denied.

We encourage members to use the Be Fit reimbursement form to make the Be Fit reimbursement process easier. They can find it on HealthAllianceMedicare.org.

December and January Commission Payments

January 18, 2017

The Medicare Advantage commission payment for December is on schedule and will be out next week. We’re also working as quickly as possible to process January’s Medicare Advantage commissions, and the payment for January 2017 new sales and renewals will be out by the end of the month.

Normally, our policy is to pay commissions the month after the effective date. But knowing how hard you work to sell and renew the majority of your Medicare Advantage book of business within the fourth quarter, we strive to pay January’s Medicare Advantage commissions in January.

And remember, you can review your book of business on Your Health Alliance for brokers. Thank you for your hard work and partnership.

Changing Plans Outside the AEP

January 5, 2017

Now that the Annual Enrollment Period (AEP) is over, you might have questions about how members can change plans during the rest of the year.

Medicare Advantage Disenrollment Period

From January 1 to February 14, during the Medicare Advantage Disenrollment Period, members can leave their Medicare Advantage plan and switch back to Original Medicare.

If they switch back to Original Medicare at this time, they’ll also have until February 14 to join a Medicare Prescription Drug Plan (PDP) to add drug coverage. That coverage will start the first day of the month after the Part D plan gets your enrollment.

They cannot:

  • Join a Medicare Advantage plan from Original Medicare
  • Switch from one Medicare Advantage plan to another
  • Switch from one PDP to another
  • Join, switch, or drop a Medicare Medical Savings Account Plan

Remember, members who qualify for Extra Help (LIS) might have other options.

Special Enrollment Periods

Outside the AEP, Medicare beneficiaries can only enroll in a Medicare Advantage plan or PDP after a special event with a Special Enrollment Period (SEP).

To enroll during an SEP, we must receive an Attestation of Eligibility form, which must include the date of the qualifying event, with the application. CMS requires us to get that date, so applications won’t be processed until it’s confirmed.

Remember that members affected by the non-renewal of their plan, such as the non-renewal of the Health Alliance Medicare PPO, have an SEP through February 28, 2017 to choose a new plan.

You can find enrollment forms and attestation forms on HealthAllianceMedicare.org or on Your Health Alliance for brokers in the Forms & Resources.

Learn more about the types of SEPs, when coverage will start, and other enrollment periods on the Understand Medicare section of our website.

CMS Increases the Medicare Advantage Gift Limit

January 3, 2017

In a December 7 ruling, the Office of Inspector General (OIG) decided that the allowable annual aggregate value of nominal gifts* that a Medicare health plan can give to prospective or existing Medicare beneficiaries is $75.

CMS agreed and increased the Medicare Advantage limit from $50 to $75 per year, effective immediately. This change will be reflected in next year’s release of the Medicare Marketing Guidelines.

 

*At any one time, health plans may continue to offer gifts to potential enrollees as long as such gifts are of nominal value and are provided whether or not the individual enrolls in the plan. Nominal value currently is defined as an item worth $15 or less, based on the retail purchase price of the item regardless of the actual cost.

Error in Illinois POS SOBs

December 20, 2016

There was an error in the Illinois Point of Service (POS) Summaries of Benefits (SOBs) that were included in sales kits. The out-of-network preventive services were listed as “No cost to you” on all Illinois POS plans (including Rx). POS 10 and POS 10Rx plans should show a $30 copay, and all other Illinois POS plans should show a $50 copay.

This information was only incorrect in sales kits. It was correct in the Evidence of Coverage that was sent to each new member.

We have updated this information on our Medicare site and Your Health Alliance for brokers and in our printed sales kits. Please make sure you’re using the updated versions of these SOBs.

We’re sorry for the inconvenience and appreciate your help replacing this in your materials.