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June 10, 2019

Why 250K Medicare beneficiaries are about to be hit with an unexpected bill

Daily Briefing

    An estimated 250,000 Medicare beneficiaries can expect to get bills for up to five months of premiums they likely thought already had been paid, but had not because of a "processing error" that occurred in January, according to the Social Security Administration (SSA).

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    About the error

    According to Kaiser Health News, Medicare beneficiaries have two main ways to pay insurance premiums. Beneficiaries can pay the premiums directly via credit cards or a checking account, or they can have premium payments automatically deducted from their Social Security checks.

    However, CMS and SSA recently announced that, due to a technical error, many premiums for beneficiaries enrolled in Medicare Advantage (MA) plans and Part D plans went unpaid.

    As a result, some beneficiaries are receiving bills from their insurers to recoup the missed payments—and in a few reported cases, beneficiaries have had their coverage canceled. For example, Vicki Dufrene, director of Louisiana's Senior Health Insurance Information Program, said at least two seniors in the state had their coverage terminated, including one woman who had to go without coverage for an entire month.

    Neither CMS nor SSA explained how the error happened, and they did not provide a more exact number of the beneficiaries or health plans affected, KHN reports.

    Mark Mathis, a spokesperson for Humana, said about 33,000 of its members were affected, amounting to fewer than 1% of its total Medicare membership, and none of those members lost coverage. Humana blamed Medicare's almost 15-year-old IT systems for the error.

    A representative from UnitedHealthcare said 32,000 of its MA and Part D members were affected by the error, but none lost coverage. Daily Briefing is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare.

    Ethan Slavin, a spokesperson for Aetna, said the error affected 43,000 of its MA and Part D plan members. Slavin said the company is missing payments for February, March, April, and May from affected members. These members will receive bills for the unpaid amounts and will be allowed to set up payment plans if they cannot pay the entire amount, Slavin said.

    CMS and SSA said they expect the deductions and payments to insurers to be working properly either this month or next.

    CMS in a notice to beneficiaries wrote, "If you receive a bill from your plan, your plan must offer you a 'grace period' to repay your premium payments that were missed. This period must last at least as long as the delay in billing."

    Lawmakers seek answers

    House committee leaders sent a letter to CMS Administrator Seema Verma and acting Commissioner of Social Security Nancy Berryhill looking for answers.

    The letter from House Ways & Means Committee Chair Richard Neal (D-Mass.), Oversight Subcommittee Chair John Lewis (D-Ga.), and Subcommittee on Social Security Chair John Larson (D-Conn.) asked CMS and SSA a series of questions, including how the problem was discovered, what actions were taken to correct the error, why the error occurred, and how CMS is telling beneficiaries about the error.

    The lawmakers wrote, "For vulnerable seniors and people living on fixed incomes, getting a bill for several months of unpaid MA or Part D premiums could lead to significant and potentially ongoing hardship."

    The lawmakers asked that CMS and SSA respond to their questions by May 29, but a spokesperson said the House Ways & Means Committee has not yet received a response from either agency (Jaffe, Kaiser Health News, 6/6; Stein, Inside Health Policy [subscription required], 5/29; Owens, "Vitals," Axios, 6/7).

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