MedicareBlue PPO will not renew its contract with the Centers for Medicare & Medicaid Services (CMS) for 2013. MedicareBlue PPO is a regional PPO Medicare Advantage plan with prescription drug coverage included.

MedicareBlue PPO currently has approximately 4,300 enrolled individuals in Iowa and South Dakota:

• Approximately 3,200 in Iowa (including 110 group members)
• Approximately 1,100 in South Dakota

Each year, health and drug plans that have contracts with Medicare have the option to renew that contract with CMS. This year, the six Blue Cross and Blue Shield plans, covering seven states, that offer MedicareBlue PPO wanted to focus on local Medicare plans in their product portfolios, which ultimately led to the decision to not renew the MedicareBlue PPO contract.

Approximately 1,100 members in South Dakota and 3,200 members in Iowa will receive formal non-renewal notices. The South Dakota notice is mailing on Friday, Sept. 21 and the Iowa notice is mailing on Monday, Sept. 24. These members can enroll in another plan once the Annual Enrollment Period (AEP) begins on Oct. 15.

Providers who have a MedicareBlue PPO contract with Wellmark will be receiving a letter in October from Wellmark about the plan closing effective Dec. 31, 2012. 

Plan closing details

More details about closing out claims will be shared closer to the plan closing date.

Meanwhile, here are some high level details:

• If a patient is hospitalized on Dec. 31 in an acute care, long-term care, psychiatric or rehabilitative hospital, their care will continue to be covered by MedicareBlue PPO until they’re discharged to another level of care.
• If the patient is in the middle of an outpatient treatment regimen, MedicareBlue PPO coverage for that treatment will end on Dec. 31, 2012. The patient’s new plan will assume coverage at whatever cost-sharing may apply.
• MedicareBlue PPO claims will be paid for a number of months following the closure of the plan. The specific timeframe depends on the provider agreement and CMS out-of-network (non-par) requirements.
• Adjustment requests/provider appeals will be accepted and processed according to CMS guidelines for out-of-network (non-par) claims. The specific timeframe for in-network (par) claims will be in accordance with provider contractual agreements.

Website updates

The MedicareBlue PPO information on www.YourMedicareSolutions.com will be updated as of Oct. 1, 2012, to state that the plan is not renewing for 2013. After Dec. 31, 2012, the information on the website will be limited to the specific information needed by members or providers for run-out claims processing.