Oxford News: Claim Payment Changes Impact Medicare Eligible Members

Oxford’s new claim payment changes impact Medicare eligible members

For years Oxford has not specifically required members who were Medicare eligible to have both Medicare Part A & B. Effective July 1, 2020, this will end because of a change in how Oxford pays their claims. This is important for Medicare eligible members because Oxford will be applying the Medicare Estimation claims process. In other words, the amount Oxford pays will be reduced by the amount Medicare would have paid if the eligible member was enrolled in Medicare Part B coverage.

This coverage change is most critical for employees covered on an employer plan with 1-20 employees as under most circumstances those group policies are set up with Medicare as the primary payer for Medicare eligible members. After July 1, 2020 any payments Oxford makes for those members would be reduced assuming that Medicare has already paid their portion as primary payer. If the member is not enrolled in Medicare Part B, the member would be responsible for the remaining balance.

Therefore, Medicare eligible members covered on an employer plan with 1-20 employees should consider enrolling in Part B during thecurrent Medicare Part B open enrollment period: January 1, 2020 – March 31, 2020.

Oxford has advised that letters outlining this change are being mailed directly to members who have a New York fully insured small (1-100) or large group (101+) medical plan and are enrolled in Medicare Part A, but not Medicare Part B coverage.

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