With Medicare's Oct 15, 2024 launch of the Open Enrollment Period (OEP) , Avisery would like to draw attention to a few noteworthy issues that may affect your clients’ 2025 coverage, including: plans exiting the market, the persistence of sanctioned plans in Illinois, and the notices clients receive regarding these plan changes. Keep reading further for key highlights.
Insurance Plans Leaving the Market
Mutual of Omaha has pulled their Part D prescription drug plans off the Medicare Market in Illinois. Among Medicare Advantage (MA) plans, the United Healthcare Complete Care (PPO C-SNP) plan will also no longer be offered in Illinois. These plans will have sent their current enrollees a Plan Non-Renewal Notice indicating coverage ending as of Dec 31, 2024. Beneficiaries should keep an eye out for these notices and should begin reviewing options for obtaining new prescription drug coverage as of Jan 1, 2026.
Individuals whose Part D drug plan or Medicare Advantage Part D plan are terminating can utilize a special enrollment period (SEP) that runs from December 8, 2024 to the last day of February 2025 to select new a drug plan. Using this SEP, enrollment decisions made before December 31, 2024 will be effective Jan 1, 2025, while coverage for enrollments made during January and February of 2025 will be effective the first of the month following enrollment.
Additionally, beneficiaries whose Medicare Advantage plan has terminated and who wish to return to Original Medicare instead of choosing a different MA plan should hold on to their notice of non-renewal as proof of eligibility to receive “guaranteed issue rights” should the individual chooses to enroll in a Medigap plan. These rights ensure that insurance carriers cannot refuse to sell a Medigap plan to the individual nor can they require the applicant to undergo medical underwriting for pre-existing conditions.
Plans Leaving the Market That Will Reassign Enrollees to Other Plans
Aetna will stop offering Illinois residents two of their SilverScript drug plans (PDP) in 2025. Instead of ending coverage for these enrollees, Aetna will utilize a crosswalk process to reassign clients currently enrolled in the SliverScript SmartSaver or SilverScript Plus to the remaining SilverScript Choice plan. With a 2025 monthly premium of $44.90 for the SilverScript Choice plan, beneficiaries currently paying only $9.99 a month for the SmartSaver plan will face a substantial cost increase if they do not choose a different plan. Enrollees in the two terminating plans will learn of their new plan assignment in their Annual Notice of Change (ANOC). Those beneficiaries looking for more affordable coverage should review other Part D options and enroll in a new plan during OEP. Even if costs are not a concern, beneficiaries should confirm coverage of their current prescription drugs under the new plan to which they have been assigned.
Potential Dec 31st Termination of Clear Spring Part D Plans
In October 2023, the Medicare program announced that, due to persistently low quality ratings, the Clear Spring Health Value Rx and Clear Spring Health Premier Rx were scheduled to be terminated as of Dec. 31, 2024. Clear Spring has appealed that decision, and while the appeal is being heard, current enrollees may be unaware that their coverage could be ending this year While confident that CMS will offer appropriate opportunities for customers to choose new coverage should Clear Spring lose its appeal, Avisery recommends that professionals advise their clients who are enrolled in Clear Spring plans to remain vigilant for a notice of non-renewal that could arrive before the end of the year and/or to use the current OEP to explore other plans as alternative coverage.
Timely Takeaway: Clients Should Watch Their Mail
As demonstrated by the variety of changes in the Illinois Medicare market, OEP is a time where clients may be receiving multiple letters from a variety of sources: the Center of Medicare and Medicaid Services (CMS), insurance plans, and Social Security. CMS has a mailing guide that reviews all the mailings a person may receive and what action needs to be taken. Some of these mailings can be identified by what color of paper they are. For example, if your client is in one of the plans that are being terminated, they should be receiving a blue letter from CMS.
Avisery by AgeOptions provides tools and support to professionals serving older adults and people with disabilities, enabling them to help their clients access healthcare coverage that allows them to thrive as they age. Contact us at avisery@ageoptions.org or 708-628-3440.
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