Medicare Plan Finder to Indicate which MA, Part D Plans Have Been Sanctioned

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CMS revealed last week that Medicare Plan Finder soon will note for users whether a Medicare Advantage plan or Part D prescription drug plan has been sanctioned.

The Medicare Plan Finder is an online tool that allows consumers to search for a plan based on general criteria (a zip code) or personal criteria (name, Medicare number, and date of birth).  Plan Finder displays estimated costs, premiums, co-payments, deductibles, and star ratings, along with the option to enroll.

Starting in October, Plan Finder users also will be able to see which managed care and drug plans have been sanctioned and the violations underlying those sanctions, CMS officials announced during the Medicare Advantage & Prescription Drug Plan Fall Conference & Webcast on Thursday, September 8, 2016.

In addition, the sanctioned plan’s premiums, drug copays, and other information will only be available to beneficiaries already enrolled in that particular plan.  Users cannot enroll in the sanctioned plans through Plan Finder, but CMS indicated it will stop hiding sanctioned plans in Plan Finder in an effort to promote transparency.  Instead, when a user selects the sanctioned plan, a pop-up window will link to a sanction notice.

CMS sanctioned Cigna Corporation in January, thus prohibiting Cigna from enrolling new members, though current Cigna members may renew their plans.  Medicare Advantage’s 2017 open enrollment begins October 15, 2016.

In addition, CMS requested input on changes to its star ratings, including the effect of sanctions on those ratings.  In March, CMS ceased the automatic reduction of plan star ratings to 2.5 stars for sanctioned contracts (or one-star reductions for contracts already at 2.5 stars or worse).  CMS indicated it is considering changes to those star reduction policies and asked for feedback by September 23, 2016.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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