UPDATE

In the past week there has been much confusion and misinterpretation of the notification by CMS of the "Special Election Period" (SEP) for Medicare +Choice patients. The original CMS Press Release is included in this mailing. Also, attached is a copy of a letter from CMS to Medigap Insurers or Agents for your further reference.

The CDC has been working with CMS, the Senate Committee on Insurance and the Health Insurance Counseling Advocacy Program (HICAP) to obtain clarification for ESRD patients.

ISSUE: A number of Medicare +Choice HMO plans have announced that effective January 1, 2002 their ESRD beneficiaries will have to pay a co-payment for each dialysis treatment, along with other co-pay changes. For many patients this payment will be prohibitive (appox. $325 + per month).

CLARIFICATION: During this SEP patients CANNOT change from one Medicare +Choice plan to another. However, they can disenroll from there Medicare+Choice plan, return to regular Medicare Fee For Service (FFS) and then enroll into a Medigap plan. All Medicare+Choice patients are entitled to guaranteed issue of Medigap policies A, B, C, F or H, I, J at the option of the company. That is to say that if a company doesn't offer drug policies (H, I, J) they do not have to offer one during this SEP. If they offer all three the they (the company) can elect which one they will provide. This guarantee issue of Medigap policies includes Medicare beneficiaries who are Medicare by virtue of ESRD and are 64 years of age and under.

If they qualify, patient may also disenroll from there Medicare+Choice plan, return to regular Medicare Fee For Service (FFS) and then apply for Medi-Cal.

The Health Insurance Counseling Advocacy Program (HICAP) can be a great resource on this issue. To find the office nearest you please call (800) 434-0222.

Please Note: This "Special Election Period" (SEP) ends on December 31, 2001.

PLEASE SHARE THIS INFORMATION WITH YOUR SOCIAL WORKER

Original Press Release sent to CDC Members December 7, 2001

CDC Members,

CMS Press Release (below) indicates that ESRD patients covered by Medicare now have one more month in which to decide whether they want to stay in a Medicare+Choice plan or return to original fee-for-service Medicare. And because this December is a Special Enrollment Period, Medicare patients 65 years and older can now buy a Medigap policy without worrying about their medical history."

FOR IMMEDIATE RELEASE
CMS Public Affairs Office
December 4, 2001

DECEMBER MEDICARE+CHOICE SPECIAL ENROLLMENT PERIOD MEANS MORE OPTIONS FOR PEOPLE WITH MEDICARE

Individuals who are currently enrolled in Medicare+Choice plans have an additional month to make a choice about how they wish to receive their health care coverage in 2002. During the month of December, Medicare beneficiaries may choose to leave their Medicare+Choice organization and purchase certain Medigap policies without any pre-existing condition
exclusions.

Earlier this year, HHS Secretary Tommy G. Thompson declared the month of December a Special Election Period for the Medicare+Choice program to give Medicare beneficiaries more time to decide what type of health plan option they wish to have in 2002. The Secretary's action for beneficiaries coincided with his extension of the deadline for health plans to notify the Centers for Medicare & Medicaid Services if they wished to remain in the Medicare+Choice program in 2002.

"People who are covered by Medicare now have one more month in which to decide whether they want to stay in a Medicare+Choice plan or return to original fee-for-service Medicare," said CMS Administrator Tom Scully. "And because this December is a Special Enrollment Period, they can buy a Medigap policy without worrying about their medical history."

Medicare+Choice was created in the Balanced Budget Act of 1997 to provide people who are covered by Medicare with additional health plan choices. Medigap, or Medicare supplemental policies, are individual health insurance policies that people who in the original fee-for-service program purchase to help pay for costs or services not covered under Medicare.

Under Medigap law, if the HHS Secretary declares a Special Enrollment Period based on exceptional circumstances, all enrollees in the Medicare+Choice plans have what is known as guaranteed issue rights to Medigap plans A, B, C or F. The only requirement this year is that the beneficiary must leave the health plan they are currently enrolled in no later than December 31. If a beneficiary chooses to purchase a Medigap policy, the policy must be bought by March 4, 2002, 63 days after their coverage in the Medicare+Choice plan ends.

Note: For other CMS Press Releases and Fact Sheets please visit our Press Release and Fact Sheet searchengine at http://www.hcfa.gov/pubaffr.htm