Background
The Centers for Medicare and Medicaid Services (CMS) will terminate the Clear Spring Health Value RX (PDP) plan on 12/31/2024 due to performance issues and will offer an SEP for affected beneficiaries to obtain new prescription drug coverage. Avisery suggests that professionals communicate to clients who are Clear Spring Health Value RX enrollees that they must pick in a new plan by 2/28/25 to secure 2025 drug coverage and avoid late enrollment penalties in the future (provided they do not qualify for a different Special Enrollment Period at a different time of the year).
To obtain drug coverage effective as of January 1, 2025, however, individuals must enroll in a new plan by December 31, 2024. CMS has advised that members should call 1-800 MEDICARE to enroll in a new plan. To ensure that those Illinois Clear Spring members receiving Extra Help assistance with their prescription drug costs do not experience any coverage gaps, CMS will automatically enroll those members into the Wellcare Value Script Extra Help benchmark plan.
Please note that Clear Spring sent a termination notice to all plan members in mid-November informing them of the plan's termination on 12/31/2024. This notice contradicted information in their October Annual Notice of Change (ANOC) letter that indicated the plan would be operational in 2025. This conflicting information may create confusion for beneficiaries about which notice is more accurate.
Please feel free to reach out to Avisery if you need further guidance on assisting clients or patients with this matter at avisery@ageoptions.org or 708-628-3440.
