Federal Government Determines Cigna Medicare Advantage Network Change Requires Special Election Period

The Delaware Department of Insurance and its Medicare Assistance Bureau (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 termination. They have determined that this termination significantly changes the Cigna provider network. Affected enrollees qualify for a Special Election Period (SEP), allowing them to switch plans starting from the month of notification and lasting two months beyond. Those opting for Original Medicare during this period will have Guaranteed Issue rights for Medigap coverage, ensuring they cannot be denied enrollment based on health status.

Additional Information from the Delaware Department of Insurance:

 The Guaranteed Issue rights begin 60 days before the Medicare Advantage Plan coverage ends and end 63 days after the Medicare Advantage coverage ends.

Consumers engaged in Cigna Medicare Advantage coverage through an employer-sponsored plan should note that provider terminations are subject to the same CMS requirements for determining Special Election Periods. 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 Special Election Period eligibility with a letter that must include information about the Special Election Period and their right to Guaranteed Issue Medigap coverage. Consumers are encouraged to contact the Delaware Medicare Assistance Bureau 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 Medicare Advantage 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 Special Election Periods.

About the Delaware Medicare Assistance Bureau

The Delaware Medicare Assistance Bureau 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, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more. insurance.delaware.gov/dmab

View this release on Delaware.gov