Selected Medicare/Medicaid (dual eligible) members in South Carolina are being passively enrolled into Medicare-Medicaid Managed Care Plans (MMP) and dis-enrolled from their current Humana plans.
In states where Humana does not offer a MMP plan (such as SC, CA, TX, NY, MA & MI), impacted members have received or will receive notices that they are being passively enrolled into plans with alternative MMP carriers and dis-enrolled from their Humana Plan. In states where Humana does offer a MMP plan (such as VA & IL), impacted members received notices that they would be dis-enrolled from their regular Humana Medicare plan and passively enrolled into either a Humana MMP plan or an alternative carrier’s MMP plan. At this time, we are only aware of passive enrollments occurring in South Carolina. If you are an agent licensed to sell in South Carolina, please read through the important guidance below on how to help these members.
What Does This Mean To Agents
It is very important that agents know where to direct these impacted members. CMS has been conducting test calls to ensure these members are being provided accurate information.
The South Carolina Department of Health and Human services will be sending out notices to impacted members at the end of January, 2016. These individuals may be confused and call in with questions about why they are being dis-enrolled from Humana and what they need to do if they want to keep their current Humana plan and “opt-out” of passive enrollment into a MMP plan. It may sound like the member is experiencing a plan exit, please do not assume that is the case when a member states they are being dis-enrolled from their Humana plan. Ask them questions about what the notice/letter they received says to make the determination.
Key Words to Listen For
Caller mentions a State and or State MMP program name such as:
- Healthy Connections Prime (South Carolina)
- Cal MediConnect program (California)
- OneCare Connect CalOptima (Orange County, CA)
- Virginia Commonwealth Coordinated Care
- Illinois Medicare-Medicaid plan
- MyCare Ohio
- STAR+PLUS Medicaid-Medicare Plan (Texas)
- FIDA Program (New York)
- MI Health Link (Michigan)
Caller mentions receiving a disenrollment letter from Humana with the reason listed as having been enrolled in a different plan.
- Caller may also state that they did not enroll in a different plan (indicating passive or auto-enrollment by the State).
Caller mentions receiving a letter that contains language such as:
- “What if I don’t want to join?”
- “What if I want to opt out?”
Steps To Follow
- Identify them as an impacted member.
- Provide the member with the number to Humana’s Billing & Enrollment department: 1-800-457-4708
Humana’s Billing and Enrollment department will be able to access their member account information, answer questions, and direct them to the appropriate state enrollment service center. Do NOT direct them to Medicare.