States to Federal Medicare Program Managers: Please Talk to Us

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State insurance regulators have something in common with consumers and their health insurance advisors: problems with getting authoritative advice about Medicare enrollment rules.

Members of the Senior Issues Task Force, an arm of the National Association of Insurance Commissioners, talked about the problems last month in Denver, at an in-person session at the NAIC's fall national meeting.

Insurance regulators told Molly Turco and Kathryn Coleman, two officials at the federal Centers for Medicare and Medicaid Services, about their difficulty with finding out what CMS wants them to tell consumers when a Medicare Advantage plan shuts down, makes big changes to its provider network or cuts medications from the list of drugs it covers.

Eric Dunning, Nebraska's insurance director and a former government affairs director at Blue Cross and Blue Shield of Nebraska, said getting a four-paragraph letter from CMS responding to questions took Nebraska six months, according to draft meeting minutes posted on the Senior Issues Task Force website.

In some cases, Nebraska insurers that ask CMS the same question get different answers, Dunning said.

Jill Kruger, an official with the South Dakota Division of Insurance, said that, as of the date of the session in Denver, her state had not received any response from CMS to its questions.

Nevada Insurance Commissioner Scott Kipper suggested that CMS could ask for help with communications from states' State Health Insurance Assistance Program offices.

Turco told the regulators that CMS is trying to develop a better, official process to get state officials the information they need more quickly.

Shortly after the meeting, CMS sent the task force a document providing answers to many of officials' questions about the rules for consumers affected by Medicare Advantage plan exits and benefit changes.

What it means: Medicare program managers and staff members may need lobbying support from financial services groups to get the resources they need to improve their ability to answer complicated enrollment questions.

The backdrop: CMS is the arm of the U.S. Department of Health and Human Services that runs the Medicare Advantage program, which gives private insurers a chance to sell managed care plans to Medicare enrollees.

CMS also sets the guidelines for when stranded Medicare Advantage plan enrollees can qualify for "special enrollment periods" for another type of Medicare-related coverage, Medicare supplement insurance.

Original Medicare exposes the enrollees to big bills for deductibles, co-payments and coinsurance payments. In theory, a Medicare Advantage plan enrollee with cancer or hemophilia who returned to original Medicare without Medicare supplement insurance could face an unlimited amount of medical bills.

All consumers get a chance to sign up for Medicare supplement insurance without going through medical underwriting for six months after they sign up for Medicare Part B hospital outpatient and physician services coverage.

In most states, after that open enrollment period is over, consumers must go through medical underwriting to buy Medicare supplement insurance. In those states, to sign up for Medicare supplement insurance without going through underwriting after the end of the initial open enrollment period, a consumer must qualify for a special enrollment period.

A consumer without assets may be able to go bare or qualify for programs that help low-income people.

For a client with substantial assets and serious health problems, moving to original Medicare without a Medicare supplement insurance special enrollment period could mean having to sell assets to pay medical bills.

Credit: Centers for Medicare and Medicaid Services; Shutterstock