Share of Cost, Anthem Blue’s Local PPO Plan Terminated in 6 California Counties

Thursday, Jul. 25th 2013 7:15 AM

Several beneficiaries from 6 California counties have been calling their local Health Insurance Counseling and Advocacy Program (HICAP) about their plan’s termination notice. These beneficiaries are enrolled in the Anthem Blue local PPO plan called Anthem Medicare Preferred Standard. They received a letter in late October letting them know that their plan is terminating as of December 31; it is not renewing their contract with Medicare for 2013. Yet this letter arrived 3 weeks past the October 2 deadline for plans to notify their enrollees of any non-renewal for next year. Furthermore, what makes this situation confusing for beneficiaries is that Anthem Blue is offering a new local PPO plan in 2013 with the exact same name (different plan ID number) but with much higher premiums and maximum out-of-pocket (MOOP) amounts.

If you know of affected beneficiaries in these counties (Sacramento, San Diego, San Francisco, San Mateo, Sonoma and Ventura), please help let them know that they need to actively choose their new coverage for the coming year. Because Anthem Blue’s 2012 local PPO is not renewing, plan members have a Special Election Period (SEP) to join a different Medicare Advantage plan (between December 8 and February 28) AND a guaranteed issue right to by a Medigap policy.

Below is a brief summary of their options:

Change to a different Medicare Advantage plan. Beneficiaries can make this change during the Annual Election Period (October 15 – December 7), or during their SEP (December 8 – February 28). Again, beneficiaries should be reminded that the new Anthem Blue local PPO is a different plan even though it has the same name. If a beneficiary wants the new Anthem Blue local PPO plan, they need to affirmatively enroll, understanding that the premium and maximum out-of-pocket (MOOP) amounts are higher. They will not be passively enrolled (or cross-walked) into the new Anthem Blue PPO.

Return to Original Medicare. Beneficiaries can go back to Original Medicare by enrolling in a stand-alone Part D plan during the Annual Election Period (AEP) or SEP. If they do nothing, they will be automatically enrolled in Original Medicare and not have prescription drug coverage as of January 1, 2013. Those who return to Original Medicare can also use their guaranteed issue right to buy a Medigap policy.


Posted on Thursday, Jul. 25th 2013 7:15 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, Anthem Blue’s Local PPO Plan Terminated in 6 California Counties