Last updated June 21, 2024
When to use:
Caller's MSHO is ending and has questions about the grace period and how the A and B benefits work.
Grace periods:
The grace period is a benefit to ensure transitional coverage of individuals leaving MSHO or Integrated SNBC plans only. The grace period allows time for an individual to obtain prescription coverage through a Part D plan.
The grace period:
- lasts 90 days or until a person chooses a new Part D plan
- is coordinated through the plan itself
MMIS will reflect that the MSHO/Integrated SNBC has ended (this is normal). The plan may also show that the coverage has terminated, matching MMIS.
Medicare is the source of truth for current coverage. Medicare will still show the MSHO/Integrated SNBC as active for up to 90 days or until a person chooses a new Part D plan.
Coverage in the grace period:
The grace period provides Original Medicare (Part A and Part B) benefits along with Part D benefits for those terminating Medical Assistance (i.e., no coverage of deductibles, copays, or coinsurance for health benefits and over the counter meds will no longer be covered).
The grace period provides all MSHO/Integrated SNBC benefits for those that remain MA eligible and are moving to a different plan or straight MA. In this case, it is possible MMIS and the plan (if not on straight MA) will show MSC+ or non-integrated SNBC as the current active plan, but Medicare will still show the MSHO/Integrated SNBC as active.
Does my caller have a grace period?
- Call the pharmacy.
- Make sure the medication is being billed under the MSHO/Integrated SNBC plan
- What is the rejection? If it says the plan has terminated, proceed to step 2.
- Look the person up in MMIS.
- Is Medical Assistance ending?
- If yes, on the RPPH screen in MMIS, does the DIS RSN (disenrollment reason) show EE? If so, the person is eligible for a grace period. If not, there is likely no grace period eligibility.
- If no, the person is changing from an MSHO to an MSC+ plan, the person has a spenddown that is not being met.
- If they are continuing with Medical Assistance, the grace period is allowed.
- Call SHIP
- Confirm that the MSHO/Integrated SNBC plan is still showing as active with Medicare.
How to get help with grace period issues:
- If you’ve confirmed with Medicare that the MSHO/Integrated SNBC plan is still showing active at Medicare and the pharmacy has confirmed that the issue with billing is that the plan has been terminated (not other issues like fill too soon, need prior authorization, etc.), reach out to the Tier 3 support chat with this information.
- Tier 3 staff will reach out to the plan to have them update their files to match Medicare’s system.
- Once the plan’s system has been updated, the pharmacy will be able to bill the MSHO/Integrated SNBC through the end of the current month.
- Complete a plan comparison with the beneficiary to ensure they have coverage for the following month. Their options will depend on whether they’ll remain eligible for Medical Assistance or not.