FamilyCare Health received approval from the Centers for Medicare and Medicaid Services (CMS) to voluntarily terminate its Medicare plans on July 1.
The decision to terminate mid-year means that FamilyCare Medicare Advantage plan members need to enroll in a new Medicare Advantage and prescription drug plan by July 31.
Individuals who do not choose a new plan will be enrolled in Original Medicare. Those members will also receive prescription drug coverage through Envision Insurance Company.
Medicare Advantage plans provide Medicare benefits to consumers and are offered by private insurance companies.
To get help choosing a plan that meets your needs:
- If you are enrolled ONLY in a Medicare Advantage plan, call a health insurance counselor with the Senior Health Insurance Benefits Assistance at 888-722-4134 (toll-free).
- If you are enrolled in BOTH Medicare Advantage and Medicaid, call the Aging and Disability Resource Connection at 855-673-2372 (toll-free) or visit http://www.oregon.gov/DHS/Offices/Pages/Seniors-Disabilities.aspx to locate a local community office.
Plan members can also get help finding a new plan by calling the national Medicare line at 800-633-4227 (toll-free).
As a Medicare insurer, FamilyCare’s request for termination was required to be submitted to and approved by the Centers for Medicare and Medicaid Services.
For more information, review the frequently asked questions below or contact the appropriate health insurance counselor.
How do I file a Medicare Advantage claim with FamilyCare?
FamilyCare will pay all claims for health care services provided on or before the last day of coverage, June 30. There is a 13- to 18-month wind-down process during which the company will continue to pay all claims and process all appeals and grievances.
Contact FamilyCare at 866-798-2273 (toll-free) for claims questions, appeals, or grievances regarding services performed on or before June 30, 2018.
How do I get help finding a new plan?
If you have a Medicare Advantage plan but are NOT enrolled in Medicaid, call the Senior Health Insurance Benefits Assistance program at 800-722-4134 (toll-free) to speak with a health insurance counselor.
If you are enrolled in BOTH Medicare Advantage and Medicaid, locate your local Aging and People with Disabilities office by calling 855-673-2372 (toll-free) or visiting http://www.oregon.gov/DHS/Offices/Pages/Seniors-Disabilities.aspx. Your local office can help you enroll in a new Medicare Advantage Special Needs Plan.
Plan members can also call Medicare at 800-633-4227 (toll-free) or visit https://www.medicare.gov/find-a-plan/ to compare and choose available plans.
How long do I have to switch plans?
Plan members should enroll in a new Medicare Advantage plan anytime between now and July 31. New coverage can start as early as the month after joining the new plan.
What happens if I do not enroll in a new plan?
Plan members who do not enroll in a new plan before June 30, will be enrolled in Original Medicare (Parts A and B) on July 1 and be auto-enrolled into a Part D prescription drug plan with Envision Insurance Company.
Envision Insurance Company will contact members about their new prescription drug plan.
Plan members who receive Medicaid and/or Extra Help, the low-income subsidy for Part D prescription drug coverage, that take no action before June 30, will be automatically enrolled into a the Envision Rx Part D plan effective July 1.
Can I enroll after June 30?
Plan members will still have the opportunity between now and July 31 to enroll in another Medicare Advantage plan, prescription drug plan, or both without penalty.
Due to the FamilyCare Advantage plan termination, members also have a guaranteed issue 63-day special enrollment period from July 1 to Sept. 1 to purchase a Medicare Supplement policy.
Medicare Supplement plans, also known as Medigap, help cover health care costs that Original Medicare does not cover, such as co-payments, co-insurance, and deductibles.
Corrections/clarification to FamilyCare Important Notice
FamilyCare sent out an informational letter about your insurance options. The section on "Your Right to Buy a Medigap Policy" (pages 5 & 6)had some inacuracies.
If you’re 65 or older, you have the right to buy all Medigap Plan types from any company selling policies in Oregon.
In Oregon, you have the right to buy a Medigap pollicy regardless of age. Call the State Health Insurance Assistance Program at 1-800-722-4134 to learn more about Medigap policies; TTY users should call 711; as soon as possible because you have a limited time to buy.