CommunityCare of Oklahoma explains loss of Medicare plans in Rogers county

TULSA -- After thousands of elderly Oklahomans learned they were losing their health benefits in 2018, many were left feeling confused and worried about the future.

However, there are many things those impacted can do to make sure they are covered in 2018. One company, dropping Medicare plans in Rogers county, is making sure customers are not left in the dark,

On Monday 2 Works for You spoke to an elderly couple in Rogers county who learned CommunityCare of Oklahoma was canceling their health plan.

“When I opened the letter, I went, ‘Oh no,’” Betty Short, a Roger's county resident said.

A letter in the mail sent the Short family into a panic.

“CommunityCare Senior Health Plan won't offer your Medicare Health Care Plan in Rogers county in 2018,” Short read.

Her reaction was common for 2,800 seniors across Rogers county in the past few weeks. CommunityCare of Oklahoma is explaining why folks received these letters, beginning with requirements established by the Center for Medicare and Medicaid Services.

“CMS has requirements around network adequacy, which requires us to ensure that we are able to provide the services that are required within that county,” Sharon Fletcher, CEO and President of CommunityCare of Oklahoma, said,

Unfortunately, based on adequacy guidelines, CommunityCare's Medicare services had to pull out of Rogers county, and it hasn't been easy.

“For us, it was very difficult because we certainly care deeply for our members and wanted to get that message out to them as quick as possible,” Fletcher said. 

CMS gave the company a quick turn-a-round to notify members and send out letters. This process is based on the requirements of CMS, meaning no indication of losing benefits could be given to customers prior to the letter. 

“Decisions like this are really difficult, getting that message across and lending a helpful hand to those individuals, because this is critical,” Fletcher said.

The company is giving members affected several resources to transition to other providers with comparable coverage. This includes a help line at (918) 594-5323, available from 8 a.m. to 8 p.m., seven days a week.

“One of the things we want to make sure is that we are affording that transition,” Fletcher said. 

She said representatives with CommunityCare are available to discuss what's next for Medicare customers in Rogers county.

Along with the letter customers in Rogers county received was a document with a list of potential providers for customers to choose from.

CommunityCare was not the only provider to drop coverage. Blue Cross Blue Shield also dropped Medicare Advantage Prescription Drug plans in some counties as well, along with some plans offered by Humana.

The fear of losing benefits is common, but local agencies want to ensure seniors there are solutions, some even identical to the plans they are losing.

Agents said if a Medicare beneficiary loses their Advantage or drug plan, they get a Special Enrollment Period (SEP) to choose another Medicare Option. This begins Dec. 8 and goes through the end of February.

Seniors also get their regular Fall Annual Enrollment Period (AEP) Oct. 15 through Dec. 7. However, if a decision is not made by Dec. 31, there will be a gap in coverage for anything but Medicare Part A and B until a decision is made. This means a loss in Part D pharmacy drug coverage until another option is chosen.

If you are someone impacted by a change in your Medicare plan, you can call for assistance at any of the numbers listed below.

1-800-MEDICARE (633-4227) - This toll-free help line is available 24 hours a day, seven days a week.

1-800-763-2828 - The Oklahoma Insurance Department is available to answer questions about Medigap plans. This number is also available for Oklahoma’s Senior Health Insurance Counseling Program.

You can also visit Medicare.gov for further information.

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