Last updated September 17, 2024
When to use:
Current Medicare issues reported in the Senior LinkAge Line weekly email may be found here.
*These are listed in order of most recent to least recent update.
**Topics that are no longer timely are located at the bottom in the section titled "Archived topics (for reference:)".
2025 MNSure Open Enrollment:
Open enrollment for 2025 MNsure health insurance starts on Friday, November 1, and ends on January 15, 2025.
Action to take: MNSure enrollees cannot have Medicare. If you come across someone in Medicare who is also enrolled in MNSure, you will your supervisor or their designee to fill out a Support Request.
UnitedHealthcare and Minnesota health care programs:
As of January 1, 2025, UnitedHealthcare can no longer participate in the Minnesota health care programs including Medical Assistance, MSHO and Special Needs Plans. Individuals who are on these programs and are enrolled in UnitedHealthcare will need to make a new plan choice. They will receive notices from DHS about this change. If someone does not choose a new plan, they will automatically be enrolled into a different plan.
Fairview Health Services and Humana:
Reminder that several years ago, Fairview made the decision to no longer participate with Humana Medicare Advantage Plans. This is still in effect.
Essentia Health will no longer accept UnitedHealthcare and Humana:
Effective 1/1/2025, Essentia Health Care System will no longer accept people with UnitedHealthcare and Humana Medicare Advantage Plans. Essentia is sending out letters to patients to notify them of the change.
Action to take: Help callers understand that can enroll in a new plan during OEP and that if they enroll in another Medicare Advantage Plan and are not satisfied with it, they can change plans from January 1, 2025-March 31, 2025. Encourage them to make sure Essentia Health Care System providers participate in their new plan if they want to use this provider network. Learn more from Essentia Health.
Medicare information data breach:
September 2024 - WPS data breach:
The Centers for Medicare & Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) are mailing letters to 946,801 Medicare users who might have had their private health information exposed in a breach. WPS, which works with CMS, manages Medicare Part A/B claims and services. CMS is also posting a notice online with the same information for people they can’t reach by mail because their contact details are outdated or missing.
What should people affected do?
- Sign up for free identity protection WPS is offering 12 months of free credit monitoring and other identity protection services from Experian. People affected can call the dedicated Experian response line at 833-931-5700, Monday through Friday, from 8 am to 8 pm. They should have engagement number B130492 ready when they call.
- Get a free credit report Everyone can get one free credit report every year from each of the three major credit reporting agencies by calling 1-877-322-8228 or go to www.annualcreditreport.com. If they find suspicious activity on their credit report, they should call their local law enforcement and file a police report. They can also file a complaint with the FTC by contacting 1-877-438-4338 or by going online to www.ftc.gov/idtheft.
- Keep using their current Medicare card Currently, there are no reports of identity theft related to this incident. If someone's Medicare Beneficiary Identifier was affected, they will get a new Medicare card with a new number in the mail soon. In the meantime, they should keep using their current card.
April 2024 - GMA data breach:
There has been a cyberattack involving personal information related to services provided by the Department of Justice’s contractor, Greylock, McKinnon and Associates (GMA). GMA is a consulting firm that provides litigation support services in civil litigation matters. Your information was obtained by DOJ as part of investigations into Medicare fraud claims, which DOJ provided to GMA in support of those matters. No DOJ systems were impacted. To help protect identity, DOJ is offering complimentary access to credit monitoring and identity protection services with Sontiq for 24 months.
ACTION TO TAKE: Have the caller contact Sontiq at 800-916-8800.
December 2023 - MAXIMUS data breach:
CMS learned of a MAXIMUS breach effecting 407,000 beneficiaries. Impacted beneficiaries will be issued a new Medicare number accompanied by a letter.
The letter asks beneficiaries to:
- begin using the new Medicare number on December 29th and
- alert providers of their new Medicare number.
Plans will receive the related enrollment codes alerting them about the Medicare number changes. Plans have a process in place to update their internal systems accordingly. The 1-800-Medicare team has been notified.
August 2023 - MAXIMUS data breach:
What happened:
The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have responded to a May 2023 data breach in Progress Software's MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. (Maximus), a contractor to the Medicare program, that involved Medicare beneficiaries' personally identifiable information (PII) and/or protected health information (PHI). No HHS or CMS systems were impacted. CMS and Maximus are sending letters to individuals who may have been impacted notifying them of the breach, and explaining actions being taken in response. CMS estimates the MOVEit breach impacted approximately 612,000 current Medicare beneficiaries.
What you should do:
If a beneficiary's MBI was impacted, a new Medicare card with a new number will be issued to the beneficiary. CMS will mail the new card to the beneficiary's address. In the meantime, they can continue to use their existing Medicare card.
Senior LinkAge Line staff should verify MBI numbers with beneficiaries that contact us previously to ensure the correct MBI number is in the CTS.
Beneficiaries should take the following actions once they receive their new card:
- Follow the instructions in the letter that comes with the new card.
- Destroy the old Medicare card.
- Inform all of their providers that they have a new Medicare Number.
Free credit monitoring services and credit report:
CMS and Maximus are notifying Medicare beneficiaries whose PII and/or PHI may have been exposed that they are being offered free-of-charge monitoring services for 24 months. This notification also contains information about how impacted individuals can obtain a free credit report.
Free COVID tests available September 2024:
At the end of September, households can order up to four rapid COVID tests from covidtests.gov.
Sanford Health pulling out of Humana Medicare Advantage network:
Beginning January 1, 2025, Sanford Health will withdraw from the Humana Medicare Advantage Network. This change will impact 10,000 Medicare beneficiaries in Minnesota. Sanford Health is sending letters to inform patients about the update. This decision is due to issues with delays in patient care and coverage denials.
Please note, this change does not affect facilities operated by Good Samaritan Society, which is part of Sanford Health's skilled nursing care division. These facilities will remain in-network for patients with Humana SNF coverage in 2025.
Action to take: Callers affected by this should be reminded they can change plans during their Open Enrollment period (OEP) from October 15,2024 through December 7, 2024 OR during the Medicare Advantage Open Enrollment Period from January 1, 2025 through March 31, 2025.
Medicare Part D premium increases for 2025:
It will be especially important for beneficiaries to check Part D premium prices this Open Enrollment Period as the national average monthly bid amount increased significantly for 2025 plans. In 2024 the national amount is $64.28 and in 2025 the amount is $179.45; an increase of $115.17. These amounts are the weighted average of the standardized bid amounts for each stand-alone prescription drug plan (PDP) and MA plan with prescription drug coverage (MA-PD). The base beneficiary monthly premium will be $36.78 in 2025.
Negotiated drug prices announced:
The lower, negotiated prices of the ten most expensive Medicare drugs were announced. The savings are substantial for each drug. Please see Top 10 drugs article.
Medicare Advantage Supplemental Benefits in 2025:
CMS is requiring MA plans to issue a “Mid-Year Enrollee Notification of Unused Supplemental Benefits” annually between June 30 and July 31 of the plan year. This must be personalized for each enrollee and include a list of any supplemental benefits enrollees didn’t use during the first six months of the year. The notification will also include the scope of the benefit, cost-sharing, instructions on how to access the benefit, any network application information for each available benefit, and a customer service number to call if additional help is needed.
HealthPartners and United HealthCare:
HP and UHC have not reached any agreement for 2025. As a result, if the UHC enrollees want to see a HP provider in 2025, they will need to review their options and enroll in a new plan for 2025. There are a large number of retirees that are in this plan, which is a complicated situation. If they drop their retiree plan they cannot get it back, so the decision the make is a critical one. SLL should do the following when assisting the UHC enrollees that want to continue seeing HP providers in 2025:
Find out if the beneficiary is a retiree or a regular UHC Medicare Advantage enrollee.
- Retiree – (a) advise they call their human resources dept to find out what the company plans to do for a 2025 plan option. If they do not get an adequate response, advise the bene that they could enroll in a new plan for 2025, but if they do that they would most likely lose their UHC retiree plan permanently. (b) Discuss the Medicare Plan Finder and how it can help them review and their options for 2025 beginning 10/15 . They also may want to call HP to find out what Medicare Advantage Plans HP will participate in for 2025. Help the bene if they need it.
- Non-retiree plan ben – tell them they do not need to make any changes now as there will provider changes do not take effect until 1/1/25. Inform them that OEP begins on 10/15/2024 and ends on 12/7/24 and that need to make a plan change by 12/7 if they want their new plan effective 1/1/2025 and want to see HP providers in 2025. Provide assistance if the bene needs it.
LIS Notices for 2025:
July 2024 – CMS began to identify LIS eligible individuals who will continue to automatically qualify for LIS in 2025.
If CMS determines during the Redetermination process that an individual no longer qualifies for LIS, the individual’s subsidy will end on December 31, 2024.
Mid-September 2024 – Individuals who will no longer qualify for LIS automatically in 2025 will receive, in a joint mailing from CMS and SSA, a personalized letter on grey paper explaining this loss of LIS and an SSA application for extra help to complete and return in an enclosed postage-paid envelope.
If a person’s situation subsequently changes so they again automatically qualify for extra help, CMS will send another notice letting them know that they qualify.
Early October 2024 – Individuals who will continue to qualify automatically for LIS in 2025 but will have a change in their co-payment level for 2025, will receive a personalized letter on orange paper from CMS outlining the changes that will be effective January 1, 2025.
2025 Smoothing for $2,000 drug cap:
To get ready for the $2,000 Part D drug cap coming in 2025, we're sharing information as it becomes available.
The process, known as "smoothing," will allow people to spread their out-of-pocket prescription costs evenly throughout the year with monthly payments. However, CMS will soon change the term "smoothing."
Unlike the current system where beneficiaries often face high costs at the start of the year, smoothing will let them pay in monthly installments. To use this option, beneficiaries must actively enroll; it won't happen automatically. They'll need to sign up through their Medicare Advantage or Part D plan, which must offer the option to pay monthly with a spending limit.
Important: The $2,000 cap applies only to medications covered by the Medicare Advantage of Part D plan. It does not cover Part B drug costs.
CMS expects SHIPs will help beneficiaries understand this option and make decisions about their monthly costs. Also, CMS is working on a tool in the Plan Finder to assist with this process, but it won' t be available until the end of September 2024.
Medicare Plan Finder changes for 2025 enrollment requests:
After this year's Medicare Open Enrollment, changes to the Medicare Plan Finder enrollment requests wil show up on plan enrollment sites. The updates to the model individual enrollment request form (OMB No. 0938-1378) include:
- new fields for sexual orientation and gender identity,
- new fields for enrollee assistance, including SHIP as an option, and
- CD as an option for accessible formats.
Medicare Advantage and Part D plans must use the new form for enrollment requests starting January 1, 2025.
Changes in HealthPartners Medicare Advantage Network:
Starting January 1, 2025, HealthPartners will no longer be in-network for UnitedHealthcare Medicare Advantage Plans. HealthPartners claim UnitedHealthcare denies too many coverage requests and delays payments for Medicare services. We are trying to get a copy of the letter HealthPartners will send to about 30,000 people next the first week of August.
Next year, this change will affect care at HealthPartners and Park Nicollett clinics, as well as their hospitals, including Regions in St. Paul, Methodist in St. Louis Park, and Lakeview in Stillwater. People with UnitedHealthcare plans who use these out-of-network providers will face higher out-of-pocket costs.
2025 Agent and Broker Compensation Rates, Referral/Finder's Fees, and Training and Testing Requirements:
The following will apply in 2025:
Reporting of Agent/Broker Non-compliance with Marketing Regulations
CMS requires MA plans and Part D sponsors to have a mechanism for oversight of all agents, brokers, and other third-party marketing organizations (TPMOs) who engage in sales and marketing on their behalf.
Compensation Rates and Referral/Finder’s Fees for CY 2025
The compensation amount an organization pays to an independent agent or broker for an initial enrollment must be equal to the fair market value
Limit the amount an organization may pay for referrals.
Each year, CMS publishes the FMV amounts for initial and renewal compensation as well as referral fees.
Training requirements
Require that organizations train and test all agents and brokers selling Medicare products, including employees, subcontractors, downstream entities, and/or delegated entities annually on Medicare Parts A, B, C, D, and plan specific information. Agents and brokers must achieve an 85% or higher score in order to satisfy the testing requirement.
CMS LIS Process:
In September 2024, Medicare Advantage and Medicare Part D Prescription Drug Plans will be contacting Medicare beneficiaries who will no longer qualify automatically for Extra Help/Low-Income Subsidy (LIS) in 2025. These plan outbound calls are legitimate and expected this fall. More information will be provided as it becomes available.
Medicare current beneficiary survey:
Some Medicare beneficiaries will be contacted as part of an ongoing study called the Medicare Current Beneficiary Survey (MCBS). CMS contracts with the University of Chicago, a respected social science research organization, to conduct the study known as the nonpartisan and objective research organization (NORC).
NORC will contact beneficiaries in coming weeks on the behalf of CMS. This is an exception to typical guidance that CMS will not contact Medicare beneficiaries directly. Please help beneficiaries wishing to verify the study and interviewer by:
- Advising beneficiaries of the MCBS respondent page for more information.
- Confirming the letters received match those posted at Medicare.gov
- Visiting the NORC website and entering the interviewer ID number and last name
Due to the pandemic, the process may begin with a telephone call, followed by a letter, and then scheduling an interview by phone or in-person. As NORC returns to normal operations, a professional interviewer will contact selected beneficiaries to schedule and complete the MCBS by telephone or in-person. This is an important distinction from previous efforts when CMS would not contact the beneficiary by telephone after the advance letter (rather an interviewer would come to the door).
CMS/SSA Medicare Savings Program/LIS mailing:
The letters to potentially eligible Medicare beneficiaries in MN will be mailed out the week. Please anticipate an increase in calls about these programs and screen callers for these programs. Assist with enrollment in the LIS if the caller is unable to do this on their own. Mailing schedule:
- First LIS Mailing: Late April 2024
- MSP Mailing: Late May 2024
- Second LIS Mailing: August 2024
SHIP Unique IDs:
SLL team staff had a conference call with the CMS contractor that manages the SHIP Unique IDs. During our call we discussed the problems we are having with activating some SHIP Unique IDs. The contractor agreed to work with us to review the issues individually and get them resolved asap. We impressed upon them how this is negatively affecting our work. If you do not have a functioning SHIP Unique ID, please contact the Tier 3 CSC. Thank you everyone for your patience during this very stressful time!
CMS issues rules for managing Extra Help problems:
A glitch caused some people with Medicare to get Extra Help paying for Part D costs, even though they weren't eligible. Several actions have been taken since this issue was identified to ensure people are held harmless and CMS is sending letters to those affected.
These are the two situations that letters will be sent for:
- People with Extra Help recently (2024), who aren't eligible will have their Extra Help extended until 4/30/2024.
- People who weren't eligible for Extra Help but received it one or more times before 2024.
People who are impacted DO NOT need to repay the Extra Help they were provided.
- If a caller's Part D plan is asking for back payment, tell the caller they shouldn't pay those bills.
- If a caller has already paid their Part D plan for back payment, their plan will issue a refund.
- If a caller's SSA check had premiums deducted for back payment, they should call their Part D plan.
Off label use of prescription drugs:
The Senior LinkAge Line is receiving calls about Ozempic coverae with Medicare as there is a trend with using it for weight loss. It is possible that a medication might not be covered if using t for off label use and/or that Medicare does not cover drugs for weight loss. See Off Label for more information.
ACTION TO TAKE: Please document in CTS notes if the caller is using it off label so other staff will know this with future plan comparisons.
Artificial Intelligence and Medicare Advantage:
Many Medicare Advantage Plans are now using AI in the Medicare Advantage coverage process. United HealthCare owns the primary AI tool being used and there has been a class action lawsuit brought against them. The use of AI and Medicare Advantage has resulted in many denials of coverage for SNF care. Center for Medicare Advocacy - Special Report
Hospital observation status appeals:
CMS issued the proposed rule on December 21, 2023, to establish appeal procedures to implement appeals processes for hospital patients whose status is changed from inpatient to observation status. More appeal information will be provided as soon as available.
ACTION TO TAKE: Inform callers that appeal rights will be established soon.
DHS Resumes Managed Care Disenrollment for Unpaid Spenddown:
During the COVID public health emergency, the Minnesota Department of Human Services (DHS) suspended disenrolling Special Needs BasicCare (SNBC) and Minnesota Senior Health Options (MSHO) members from their managed care plans if they did not pay their spenddowns.
Effective November 2023, DHS will resume disenrolling these members from their managed care plan when their spenddown is unpaid for a total of three months. The months do not need to be consecutive. These members remain eligible for Medical Assistance (MA) and are only disenrolled from their managed care plan.
The first disenrollments will be members whose MA coverage was renewed in July and August 2023. After that, DHS will disenroll members who have not paid their spenddown for a total of three months after their MA renewal month.
DHS will send members a notice when they have not paid their spenddown after three months, explaining that we will move them to Fee-for-Service (FFS) health coverage and when this will be effective. To be re-enrolled into managed care, members must pay all past due spenddowns. DHS will then re-enroll the member into managed care.
MSHO members who receive this notice will be directed to contact the Senior LinkAge Line if they have any questions.
ACTION TO TAKE: Assist the caller to see if their spenddown has not been paid, if it's going to be paid, and if that will make them entitled to Medical Assistance.
HealthPartners and Humana:
Reminder: Health Partners does not work with Humana Advantage since January 1, 2024. HealthPartners patients who have Humana Medicare Advantage plans are not permitted by HealthPartners to schedule appointments for 2024 with HealthPartners providers.
ACTION TO TAKE: Callers affected by this should be reminded they can change plans during the Medicare Advantage Open Enrollment Period that begins on 1/1/2024 and ends on 3/31/2024.
Archived topics (for reference):
Updated DHS documents and forms:
Minnesota Health Care Programs - Eligibility Policy Manual: 1.3.1.5 Notices
Minnesota Health Care Programs - Eligibility Policy Manual: 2.2.3.6 Medical Spenddown
Minnesota Health Care Programs - Eligibility Policy Manual: 2.4.2 Financial Eligibility
Minnesota Health Care Programs - Eligibility Policy Manual: 2.4.2.4 Long-Term Care Facility Services
MinnesotaCare:
Thousands of Minnesotans covered by MinnesotaCare need to start paying monthly premiums again this summer to keep their insurance. Monthly premiums were paused during the pandemic.
About 46,000 Minnesotans with lower incomes who rely on MinnesotaCare should watch their mail for a bill from the Minnesota Department of Human Services.
Actions to take: Enrollees must pay their premiums by the due date on their bill to avoid losing coverage. The first bill is due June 13.
Medicare And You 2025 Handbooks ready to order:
CMS has activated the website to pre-order state specific Medicare and You handbooks. The pre-order will be open from Monday, May 6, through Friday, May 24. This is the only time of year you are permitted to place large bulk orders for the handbook. Late pre-orders will not be accepted.
Please go to CMS and login to your POW account to access the pre-order. After logging in, you will see a blue “Pre-Order” button at the top left of the page. Click there to place your pre-order.
Medicare Part B drug and biological coverage:
As a result of many reported problems with Part B drug coverage, MNSHIP held a meeting with National Government Services (NGS), the Medicare administrative contractor for Part A and Part B. NSG has since updated their website about Part B drug coverage, providing better information. Thank you to the staff that brought this to our attention so positive changes could be made that affect all states in our NGS region.
Read more about Part B drug and biological coverage on the NGS website.
System glitch with LIS notices:
It has been reported that there is a problem with the LIS notices that are being mailed to beneficiaries.
Beginning April 11, 2024, beneficiaries are reporting they are receiving several yellow and/or green notices for retroactive LISs and new LISs. In the majority of situations, the beneficiary already had a Part D plan in place with the LIS. Some have received as many as 12 notices within a week to 2 week span, with a majority of letters saying the same thing.
ACTION TO TAKE: Assure the caller that they are not losing their LIS and that this is a system problem with SSA/CMS and is being corrected.
New CMS Resource about Insulin and Extra Help:
Legislative notice mailing:
The 2023 Legislative Notice to MHCP Members will start to be mailed out this week. Please note the changes that affect older adults. The Senior LinkAge Line is listed as a resource and may receive calls.
ACTION TO TAKE: Help callers understand the changes and refer to the county when appropriate.
Issues with conversion of Partial LIS to Full LIS:
Clients with LIS received letters from Medicare in September indicating they were moving from partial to full Extra Help because of the IRA. Then in October, SSA issued letters that stated they were being moved from 50% to 25% Extra Help. The only change in their incomes was the SS increase in 2023.
SSA has stated that the MAPS system on the SSA side may temporarily contradict the Medicare System. However, in December 2023, an SSA system Inflation Reduction Act update will automatically identify active partial subsidy cases that have no open issues/no pending actions and change the Extra Help eligibility category from partial subsidy to full subsidy effective January 1, 2024. SSA will release a notice starting the 2nd week of December 2023 which should clear up the confusion. The notice should emphasize that the individual does not need to do anything, that their Extra Help Level will automatically change from partial Extra Help to full Extra Help.
ACTION TO TAKE: If you receive any calls from people who receive the erroneous letters, tell them that letters correcting this information will be issued in December.
LIS and billing for premiums:
Some states are seeing large numbers of beneficiaries with LIS for 2+ years, suddenly getting premium bills from their Part D plans explaining their LIS was terminated retroactively back 1 to 2 years so they owe back premiums. These actions are in error. CMS and SSA are aware of the problems and provided the following information:
- The beneficiary LIS retroactive dates are a direct, unanticipated consequence of government data systems being out of sync. CMS is working through a resolution process with SSA.
- CMS requests MA organizations and Part D sponsors pause any collection efforts and continue to administer the Part D benefit with LIS-level premiums and cost-sharing with respect to the affected beneficiaries until further CMS guidance is available.
Ultimately, impacted beneficiaries will be held harmless for retroactive premium and cost-sharing payments. This means impacted beneficiaries do not owe the balanced listed in plan statements received. Please share this with impacted beneficiaries. Further CMS guidance will be shared as available.
ACTION TO TAKE: Submit a support request. The National Council on Aging is helping us to resolve these issues. Please make sure to get the beneficiary's approval for us to share their case information with NCOA for resolution. CMS and SSA are working to resolve these problems, but it is anticipated it will take quite some time to resolve.