Q1Medicare.com
Powered by Q1Group LLC
Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


CMS Notice of Release of Enrollment Suspension for Medicare Advantage - Prescription Drug Plan Contract Number: H5322 (Care Improvement Plus) for plan year 2021

Category: Medicare Plan Providers
Published on 2020-09-01 08:35:42
< Previous
Next >
Update:  On August 31, 2020, Centers for Medicare & Medicaid Services (CMS) stated that CMS is releasing the enrollment suspension for contract H5322 effective January 1, 2021.  Additionally, CMS will allow Care Improvement Plus to offer plans under contract H5322 to new beneficiaries during the CY 2021 Annual Election Period (AEP), which will be held between October 15, 2020 and December 7, 2020.

Read the CMS sanction release notice:
https://www.cms.gov/files/document/care-improvement-plus-sanction-release-09012020.pdf

CMS Notice of Enrollment Suspension for Medicare Advantage-Prescription Drug Contract Number H5322 (Care Improvement Plus) for plan year 2020
On September 11, 2019, the Centers for Medicare & Medicaid Services (CMS) provided notice to Care Improvement Plus South Central Insurance Company ("Care Improvement Plus") that CMS made a determination to prohibit the enrollment of new beneficiaries under the Medicare Advantage-Prescription Drug (MA-PD) contract H5322 for contract year (CY) 2020.

As a result of this determination, Care Improvement Plus will be prohibited from accepting any MA-PD plan enrollments which would be effective January 1, 2020, through December 1, 2020.  This action will include the removal of H5322 from the list of MA-PD plans from which beneficiaries may make an election during the CY 2020 Annual Election Period (AEP), which runs between October 15, 2019, and December 7, 2019.  However, Care Improvement Plus may continue to accept and process enrollments that become effective on or before December 1, 2019. 

Current members of Medicare plans under this contract (H5322) are not affected by the sanctions and may remain with their 2019 Medicare plan into 2020.  However, during CY 2020, all individual market plans offered under H5322 will be precluded from accepting any new enrollees, including those beneficiaries already enrolled in a Care Improvement Plus MA-PD plan who may want to elect a different plan offered under the same contract. 

If Care Improvement Plus submits a CY 2019 report in 2020 for H5322 that demonstrates it has achieved an MLR of at least 85%, CMS will allow the sponsor to resume accepting enrollments that become effective on or after January 1, 2021.  In such an instance, CMS would allow Care Improvement Plus to offer plans under H5322 to beneficiaries during the CY 2021 AEP, which will be held between October 15, 2020, and December 7, 2020.  In the event that the CY 2019 MLR report for H5322 again shows an MLR below 85%, enrollment under that contract will remain closed during CY 2021.  Furthermore, CMS reminds Care Improvement Plus that if it fails to report an MLR of at least 85% for five consecutive years for H5322, CMS must terminate that contract.
 
Background:
The Social Security Act requires Medicare Advantage organizations to maintain a medical loss ratio (MLR) of at least 85%. The statute further provides, that when an organization fails for three consecutive years to meet the 85% threshold, CMS must suspend that organization’s ability to accept new enrollments in the plans it offers under the non-compliant contract for the contract year following submission of the report (i.e., the second contract year after the third consecutive year in which the organization failed to meet the minimum MLR).

Care Improvement Plus has reported to CMS the following MLRs for MA-PD contract H5322: 71.3% for CY 2016, 83.9% for CY 2017, and 84.1% for CY 2018.  Based on this plan sponsor-reported information, CMS has determined that Care Improvement Plus has failed to meet the 85% MLR threshold for three consecutive years.

Read the CMS sanction notice:
https://www.cms.gov/Medicare/ Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/Downloads/ CareImprovementPlusSanction091119.pdf

News Home
< Previous   Next >



Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs


Browse News Categories
Selecting Your Medicare Plan
Star Ratings & Plan Quality
Annual Medicare Plan Changes
Enrollment Topics
Late Enrollment Penalty
Your Formulary (Drug List)
Monthly Formulary Changes
Your Medicare Plan Coverage
Pharmacies & Providers
Changing Medicare Plans
Special Enrollment Periods SEP
The Donut Hole or Coverage Gap
Donut Hole Discounts
Straddle Claims and High Costs
Out of Pocket: TrOOP and MOOP
Medicaid, LIS, & Extra Help
IRMAA - for Higher Incomes
Medicare Advantage Plans MAPD
Medicare Supplements - Medigap
Medicare Plan Providers
Marketing Medicare Products
General Medicare Part D PDP
General Medicare
Diabetes and Diabetic Coverage
Your Health & Wellness
About Q1Medicare.com


Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.


© Q1Group LLC 2005 - 2021  


Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
.