Low Performing Health & Drug Plans Get Another Year

Low Performing Health & Drug Plans Get Another Year

Low Performing Plans (LPP) get one more year. LPPs, which are Medicare Advantage plans or prescription drug plans with overall ratings of fewer than 3 stars for 3 consecutive years, were supposed to be terminated as of Dec 31, 2014, but the Centers for Medicare and Medicaid Services (CMS) has decided to give them one more year.

About 165,000 beneficiaries throughout the U.S. and Puerto Rico are in consistently low-performing plans and will receive a notice from CMS reminding them that they can switch to a higher performing plan during the Annual Election Period (AEP) between Oct 15 – Dec 7. If they miss the AEP opportunity, they still have a Special Election Period (SEP) to change to a plan with 3 or more starts in 2015. To use this SEP, beneficiaries must call 1-800-MEDICARE.

Note that:

  • This is a one-time SEP for individuals enrolled in a plan indicated with the Low Performance Icon in the Medicare Plan Finder.
  • The SEP can only be effectuated by CMS.
  • All enrollments under this SEP are prospective (no retro-active enrollments).
  • Individuals may use the SEP to disenroll from Medicare Advantage (MA) into Original Medicare.
  • A Part D coordinated SEP exists for individuals to enroll in Part D if they select an MA Private-Fee-for-Service plan as long as they make that enrollment at the same time.

Beneficiaries with questions about their plan choices can call their local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP provides free, individual and unbiased counseling on Medicare questions and ways to supplement Medicare.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.