DE Cigna Medicare Advantage (MA) Network Change Requires Special Election Period (SEP)

The information below was obtained from Delaware.gov, and published by the Delaware Medicare Assistance Burau.

To read the original publication, click here.

Cigna Medicare Advantage enrollees eligible to seek new coverage, including Guaranteed Issue (GI) Medigap.

The Delaware Department of Insurance and its Medicare Assistance Burau (DMAB) are working to make consumers aware that the Centers for Medicare and Medicaid Services (CMS), a federal agency, has completed a review of the impact of the Bayhealth-Cigna Medicare Advantage (MA) termination. They have determined that this termination significantly changes the Cigna provider network.

As a result, consumers on Cigna MA plans are eligible for a Special Election Period (SEP) beginning the month the enrollees are notified and ending two months after the month eligibility notices are received. Individuals who use this SEP to elect Original Medicare will have Medigap Guaranteed Issue (GI) rights – they cannot be denied enrollment regardless of health status. The GI rights begin 60 days before the Medicare Advantage Plan coverage ends and ends 63 days after the MA coverage ends.

Consumers engaged in Cigna MA coverage through an employer-sponsored plan should note that provider terminations are subject to the same CMS requirements for determining SEPs. Enrollees should check with their employer to determine any additional coverage options available, should they choose to disenroll from the employer-sponsored plan.

Cigna is required to notify affected members of their SEP eligibility with a letter that must include information about the SEP and their right to GI Medigap coverage. Consumers are encouraged to contact the Delaware Medicare Assistance Burau upon receipt of their notice from Cigna to discuss enrollment options.

Insurance Commissioner Trinidad Navarro notes that the department is aware of additional contracting changes between Delaware health systems and MA plans, but it is not yet known if these will be deemed significant network changes. While only the federal government has direct authority over these plans, Commissioner Navarro and colleagues from the National Associations of Insurance Commissioners continue to advocate for federal responses, including these SEPs.

About the Delaware Medicare Assistance Burau

The Delaware Medicare Assistance Burau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, MA, Medigap, long-term care insurance, billing issues, prescription savings, and much more.