Two Important Updates re: Open Enrollment
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Two Important Updates re: Open Enrollment

November 18, 2013 Learn More

Get more tips and tools to help your clients navigate Open Enrollment in our resource toolkit.

If you're a counselor helping people with Medicare to navigate Open Enrollment (Oct. 15 - Dec. 7) for 2014, you need to be aware of two important developments that may affect your clients' plan selection.

Beware of Medicare Advantage network terminations

Some Medicare Advantage (MA) plans have announced that they have terminated a significant number of their network providers for the 2014 plan year. UnitedHealthCare, as well as a number of other plans, have notified physicians, particularly specialists,  that they are being terminated from the plan’s network, as of 2014. Although plans are required to notify its members if physicians are being terminated, there are concerns that members are not receiving adequate notices. CMS has said it has not been hearing complaints from beneficiaries, and at this time, believes that plans are in compliance with regard to notices and network adequacy requirements.

As we near the end of Open Enrollment, counselors should encourage your clients to call their current (or potentially new) MA plan directly and request written verification of network physicians, especially if they are expecting to maintain a certain physician-patient relationship. (Note that the online Plan Finder may not have the most current information.) And, if you are hearing concerns from beneficiaries, encourage them to contact Medicare to voice their concerns. In addition, counselors should also share concerns and other information with their CMS Regional Offices.

The Center for Benefits is also interested to hear from counselors whether there is a concern in their community about the termination of network providers. Please email your comments to Leslie Fried.

Increasing number of plans with 5-tier formularies

The number of plans offering formularies (drug lists) with 5-tiers will increase in 2014. About 84% of plans in 2014 offer 5 or more tiers, with 73% using 4 copayment tiers (with copayments as high as $95 per drug) and one coinsurance tier, and 20% of plans using 2 copayment tiers and 3 coinsurance tiers. This growing number of tiers may cause some confusion, especially when there are additional co-insurance drug tiers which will be affected by changes in drug costs. Remember that drug prices change regularly throughout the plan year, so as the price of their cost-sharing will change. Beneficiaries may need your help in understanding why their out-of-pockets costs keep changing.


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