Mayo has not been public about which Medicare Advantage plans they will participate in. This has made it difficult for beneficiaries that want to go to Mayo clinic to make a plan decision. 
Action to take: If the caller wants to know if Mayo Clinic is an in-network provider, Senior LinkAge Line staff should do a three-way call with the caller and Mayo clinic to answer that question. 

CMS updated its notice of Medicare non-coverage (NOMNC, CMS-10123) and detailed explanation of non-coverage (DENC, CMS-10124). They now contain updates that are applicable only to people enrolled in Medicare Advantage plans. Hospitals must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025.

Effective January 1, 2025, SSA is requiring appointments be scheduled ahead of time Walk in appointments will no longer be possible.  Please refer to this SSA document.
The Senior LinkAge Line needs to provide this information to callers that need an in-person appointment with the Social Security office.

Changes to health plan offerings
First and foremost, none of these changes with HealthPartners and UCare will affect MSHO or MSC+enrollees.
DHS has informed the counties that as a result of the annual managed care contract negotiation process there will be some changes to the health plans that will be available for newly eligible members.

Effective December 1, 2024 HealthPartners will no longer be accepting new enrollees into the Prepaid Medical Assistance (PMAP) program AND MinnesotaCare, with the exception of enrollees who were previously enrolled in HealthPartners within the past twelve (12) months. Recipients that are already enrolled in HealthPartners will continue to receive their medical services through HealthPartners unless they actively make a new health plan selection during Annual Health Plan Selection (AHPS). DHS has updated the MMIS system so that HealthPartners no longer prints as an available option on the managed care enrollment form. DHS is also working to restart tracking and print new enrollment forms for any members that had been entered in MMIS to enroll in HealthPartners beginning Dec. 1, 2024.

Effective January 1, 2025 HealthPartners will no longer be accepting new enrollees into PMAP AND MinnesotaCare, with the exception of newborns whose parent was in HealthPartners at the time of birth and enrollees who were previously enrolled in HealthPartners within the past twelve (12) months.

HealthPartners also gave notice they will not be renewing their 2024 Special Needs BasicCare (SNBC) contract for 2025. Members currently enrolled in HealthPartners SNBC will continue to receive their SNBC services from HealthPartners through March 31, 2025 unless the member actively selects a different SNBC health plan or chooses to return to Medical Assistance (MA)  Fee-for-Service (FFS). Current HealthPartners SNBC enrollees who do not make an active selection of a new SNBC health plan will be passively moved to another SNBC plan effective April 1, 2025.  To minimize the number of members that need to move to a new plan in April, no new enrollments will be allowed into HealthPartners SNBC beginning December 1, 2024.

Additionally, effective January 1, 2025 UCare will no longer be accepting new enrollees into PMAP, with the exception of newborns whose parent was in UCare at the time of birth and enrollees who were previously enrolled in UCare within the past twelve (12) months. Recipients that are already enrolled in UCare will continue to receive their medical services through UCare unless they actively make a new health plan selection during Annual Health Plan Selection (AHPS).

DHS is currently working to create member notices and establish a timeline for reprinting AHPS notices that will reflect updated health plan choice options for 2025 and extend the due date for members to return their AHPS selections. This information will be shared with the Senior LinkAge Line as soon as it becomes available.

DHS created an online directory for the Special Needs Basic Care Plans (SNBC). The directory has detailed information about all the SNBC plans.

Prime Therapeutics recently has taken over processing of outpatient pharmacy service claims and related benefits, which has previously been managed by DHS.

This change only affects the fee-for-service outpatient pharmacy benefit. Managed care organizations will still handle outpatient pharmacy benefits for their members. It also affects Medicare beneficiaries who have their uncovered Part D drugs paid by Medical Assistance if they meet the criteria.

DHS recently launched a tool that people enrolled in health care programs can use to check the status of their renewal. This tool could be very helpful for the Senior LinkAge Line staff. You can access it by going to the DHS renewal look-up tool.

CMS/ACL has advised us the drug formulary and provider information is provided to CMS by the plans on a monthly basis. Formulary problems and provider issues are reported to CMS/ACL but the only way these issues will be resolved is if and when the plan sends the correct information to CMS.

A unit at DHS does the billings for spenddowns and they have been having some problems. Staff should refer callers with billing problems to DHS at 651-431-3205. This includes all billing problems including spenddown billing issues.

If an enrollee disagrees with having a spenddown or the amount of the spenddown, they should be referred to the county for these concerns. 

DHS is instructing that going forward, the counties screen and enroll Medical Assistance enrollees who become eligible for Medicare into an MSP. The screening is being added to the application processing checklist that DHS developed for the counties to use. The DHS training staff are also adding a specific training section devoted only to the MSP for the county staff.

Social Security staff are advising that beneficiaries NOT use the automatic premium withdrawal option from their Social Security check. SSA is at least 3 months behind in processing these and beneficiaries are being charged premiums when these amounts should be withheld. The Tier 3 CSC is helping these beneficiaries get the premium issues resolved, but it is taking a lot of time.

Due to the higher number of calls that we are already seeing, we have told CMS that we do not want 1-800-MEDICARE to send calls to the Senior LinkAge Line. If you receive a transfer from 1-800-MEDICARE during OEP 2025, please submit a support request. 

Clear Spring has been under sanctions with CMS for two years. Starting on January 1, 2025, people enrolled in Clear Spring won't be able to stay with this plan. They are getting letters from CMS to let them know about this change. These members will need help reviewing their options and enrolling in a new plan for 2025. 

They have a special enrollment period (SEP), which allows them to switch from their current Medicare Advantage Plan or Prescription Drug Plan to another plan. If they don't choose a new Medicare Advantage Plan or Prescription Drug Plan by January 1, 2025, they will be automatically enrolled in Original Medicare. These members will also have a Medigap guaranteed issue period. 

*The SEP timeline starts November 1, 2024 and ends January 51, 2025. 

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. 

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.

Reminder that several years ago, Fairview made the decision to no longer participate with Humana Medicare Advantage Plans. This is still in effect.

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.

At the end of September, households can order up to four rapid COVID tests from covidtests.gov. 

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.

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.

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.

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.

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.

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. 

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.

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. 

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.

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.

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: 

1. Advising beneficiaries of the MCBS respondent page for more information.
2. Confirming the letters received match those posted at Medicare.gov
3. 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). 

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

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!

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: 

1. People with Extra Help recently (2024), who aren't eligible will have their Extra Help extended until 4/30/2024. 
2. 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. 

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. 

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

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. 

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. 

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.