By Karen Courtney, Director of Programs, CareWell Services Southwest
On November 8, 2023, a computer data cleanup was conducted to correct some end-dates in the Social Security Administration Extra Help files. Due to a computer syncing issue, some Medicare beneficiaries who have “Prescription Extra Help” Low Income Subsidy (LIS) may have received incorrect notices showing they owe retroactive insurance premiums and prescription co-pays. The beneficiary LIS retroactive dates are a direct, unanticipated consequence of government data systems being out of sync. The Centers for Medicare and Medicaid Services (CMS) is working through a resolution process with the Social Security Administration (SSA).
CMS has requested Medicare Advantage organizations and Part D sponsors pause any collection efforts and continue to administer the Part D benefit with LIS-level premiums and cost-sharing with respect to the affected beneficiaries until further CMS guidance is available.
Ultimately, impacted beneficiaries will be held harmless for retroactive premium and cost-sharing payments. This means impacted beneficiaries do not owe the balances listed in plan statements received.
So, in short, do not panic. Pharmacies and prescription insurance plans have been informed of the syncing error; they have been instructed how to bill correctly. If you have questions, please contact your local MMAP office at 1-800-803-7174. We can help.
Important dates: Medicare Advantage Plan Enrollment changes can be made through March 31, 2024. New Medicare part A and Part B enrollments may be done through March 31, 2024, for those who delayed enrollment when first eligible.
