Some MA Plans Are Back-Billing Enrollees for Past Premiums

Some MA Plans Are Back-Billing Enrollees for Past Premiums

Several Health Insurance Counseling and Advocacy Programs (HICAP) have reported on a few Medicare Advantage plans that are back-billing their enrollees for past monthly premiums. Many of these plans did not bill beneficiaries for months or even years at a time and are now sending them a bill for a large lump sum. Beneficiaries receiving such bills are rightly distressed and have contacted their local HICAP offices for help.

If you are experiencing this problem or have clients who are: 1) file a grievance with the MA plan; and 2) file a complaint with CMS Region 9 Office and ask that you or your client be relieved of all payment responsibility and ask for a Special Election Period (SEP) to change to another MA plan.

CMS Region 9 Contact: Ayanna Busby-Jackson

Her email and phone number are: ayanna.busby-jackson@cms.hhs.gov; 415-744-3615.

We, along with other advocacy organizations, are collecting information on such cases to report to the Centers for Medicare and Medicaid Services (CMS). With enough cases we can strongly recommend CMS file sanctions against these plans and/or impact litigation.

Please email us with a summary of such cases.

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.