News

Medicare Advantage Health Insurance

As part of the implementation of Premier Health’s 2020 strategic plan and the uncertainty in the current healthcare economic environment, Premier Health Plan and the Centers for Medicare & Medicaid Services (CMS) have mutually agreed to terminate their Medicare Advantage contract, effective April 1, 2018. Additionally, we have made the decision to exit the commercial large group insurance market, effective January 1, 2019, and will not be renewing any existing large group employer contracts. Please note this does not impact the Premier Health Employee Plan. Premier Health has been and will remain committed to its mission of improving the health of the communities we serve.

We will continue that mission by ensuring that our Provider Services, Utilization Management/prior authorization and Claims Call Center teams remain intact and continue to be responsive throughout the transition process, which will extend beyond the dates we exit the Medicare Advantage and commercial large group markets. These teams are equipped to help ensure that you/your office receive timely resolution of your authorization requests, routine inquiries and outstanding claims issues. Additionally, you have our commitment that our provider portal and website will remain operational and will be updated timely throughout the transition process, as well.

The Centers for Medicare & Medicaid Services (CMS) is offering a Special Enrollment Period (SEP) for all affected members through May 31, 2018. All members enrolled in Premier Health Plan Medicare Advantage plans will be able to join another Medicare health plan or switch to Original Medicare during the SEP. Medicare Advantage members will receive a letter from the health plan with information about their SEP, their options and the next steps they need to take.

  • We understand this may be confusing and we will do the best we can to give you the information you need.
  • Premier Health has been and will remain committed to its mission of improving the health of the communities we serve.
  • Rest assured, Premier Health Plan will ensure that your needs as a provider are met and addressed in a timely fashion until all run out operations are completed and addressed.
  • Your patients enrolled in Premier Health Plan’s Medicare Advantage plan can either join another Medicare health plan during a SEP or switch to Original Medicare. The SEP runs through May 31, 2018.
  • If your patients do not select a different Medicare health plan prior to April 1, 2018, they will be automatically enrolled in Original Medicare and in Silverscript, a Part D plan selected by CMS for their prescription drug coverage.
  • If your patients ask you for help in selecting a new plan:
    • You can tell them to call 1-800-Medicare1-800-Medicare or visit Medicare.govOff Site Icon for help in reviewing their health plan options;
    • They can also call the Ohio Senior Health Insurance Information Program (OSHIIP) at (800) 686-1578(800) 686-1578 for assistance. Counselors are available to answer their questions, discuss their needs, and give them information about their options. All counseling is free. TTY users should call 711.
    • You can also share with your patients the full list of Medicare Advantage plans in which you participate as a network provider.
    • If you decide to assist your patient with this matter, it is important you remain neutral, assist your patient in an objective assessment of his or her needs, and review the potential options to meet those needs. You should try to help ensure your patient selects a plan that is in their best interest.
     
  • You may notice an increase, starting April 1, 2018 and continuing through early June 2018, of individuals seeking care who do not yet have an insurance card. This is because when individuals enroll in a different Medicare Advantage plan or Original Medicare, their enrollment date is effective the month after they enroll (e.g., if they enroll in a new MA plan on March 5, 2018, their enrollment effective date with the new MA plan is April 1, 2018). If individuals enroll in a new plan mid-late month, they may not get their new insurance card by their effective enrollment date.

We sincerely apologize for any inconvenience this has caused you. If you need any assistance going forward, please do not hesitate to call Provider Inquiry at (855) 514-3678(855) 514-3678.

Back to the March 2018 Issue