Former Bayhealth-Cigna members will have opportunity to shop for Medicare plans

The Delaware Department of Insurance and its Medicare Assistance Bureau announced that the Centers for Medicare and Medicaid Services has completed a review of the impact of the Bayhealth-Cigna Medicare Advantage termination.

CMS determined that this termination significantly changes the Cigna provider network and will allow former Cigna customers to switch back to original Medicare or other options. Bayhealth is the state's second largest healthcare system and has a dominant market share in Central Delaware.

Consumers on Cigna Medicare Advantage plans will be eligible for a Special Election Period beginning the month the enrollees are notified and ending two months after the month eligibility notices are received. Individuals who use this Special Election Period to elect Original Medicare will have Medigap Guaranteed Issue rights – they cannot be denied enrollment regardless of health status. The Guaranteed Issue rights begin 60 days before the Medicare Advantage Plan coverage ends and end 63 days after the Medicare Advantage coverage ends.

Consumers with a Cigna Medicare Advantage coverage through an employer-sponsored plan should note that provider terminations are subject to the same CMS requirements for determining Special Election Periods. Enrollees should check with their employer to determine any additional coverage options available should they choose to leave the employer-sponsored plan.

Cigna is required to notify affected members of their Special Election Period eligibility with a letter that must include information about the Special Election Period and their right to Guaranteed Issue Medigap coverage. Consumers are encouraged to contact the Delaware Medicare Assistance Bureau upon receipt of their notice from Cigna to discuss enrollment options.

Insurance Commissioner Trinidad Navarro notes that the department is aware of additional contracting changes between Delaware health systems and Medicare Advantage plans, but it is not yet known if these will be deemed significant network changes.

Last year, ChristianaCare failed to reach an agreement with Humana, a top-rate Medicare Advantage plan. That left customers navigating the process of choosing other options.

Earlier, ChristianaCare, the state's largest healthcare system and Highmark, Delaware's largest health insurer, rolled out their own Medicare Advantage plan.

Medicare Advantage plans have come under fire in some quarters, with state retirees fighting back against a plan to convert their Medicare Supplement coverage to the Advantage plan that requires recipients to pay extra for treatment outside the network. The General Assembly, whose members would have been affected by the change, passed a law barring the use of advantage plans for state retirees. Healthcare costs account for a large chunk of the state budget.

Backers of Medicare Advantage cite zero or low monthly charges for customers. Medicare supplements come with monthly fees that can run into the hundreds of dollars for retirees who don't have the state or their employer picking up the tab.

While only the federal government has direct authority over these plans, Navarro and colleagues from the National Associations of Insurance Commissioners continue to advocate for federal responses including these Special Election Periods.

The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for educational resources.

Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and related programs at insurance.delaware.gov/dmab