CMS has announced a change in Medicare ID cards that will begin to take effect in April 2018. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires CMS to remove Social Security Numbers from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions, such as, billing eligibility status and claim status. The MBI will be confidential and should be protected as Personally Identifiable Information. The biggest reason CMS is implementing this change is to fight medical identity theft for people with Medicare. It will better protect private health care and financial information as well as federal health care benefit and service payments.
Helping your clients with Medicare Part D coverage understand the mechanics of the Medicare Part D coverage gap can be a daunting task. We are going to cover a couple of the more difficult questions raised regarding the coverage gap in this segment.
One of the more common questions agents get asked from their Medicare clients is “what is the Medicare Part D late enrollment penalty?” It is fairly easy to explain that if a Medicare member spends more than 63 consecutive days without having Part D or creditable drug coverage, they will be required to pay a late enrollment penalty should they choose to enroll in a Part D plan in the future. The typical follow-up question is “will I have a late enrollment penalty?” This is also usually pretty easy to answer, assuming the agent asks the proper questions of the client and the client responds with accurate answers about prior coverage.
Statistically, the number of Humana’s MAPD/PDP enrollments that result in an allegation against an agent is just a small fraction of a single percent. The number of allegations that are founded as a result of investigation are just a fraction of allegations themselves, which is outstanding. Here are my root cause reasons for these strong compliance outcomes:
If you’re working through AHIP and carrier specific training currently, you may have noticed the content on Low Performing Plans. CMS plans to “nudge” consumers once again, with a reminder that the plan they’re in, if applicable, has consistently underachieved (less than 3 stars for 3 consecutive years). The beneficiary is directed to a variety of options for reconsideration at the bottom of the letter. Last year there were 525,000 members across 26 plans that were impacted. Letters go out once in October for those on these plans currently, and again in February of 2014 for those who selected a low performing plan this AEP with a 1/1/14 effective date.