This article is for providers caring for our Medicare Advantage members
We’d like to make you aware of upcoming cost share changes to Part B benefits that will happen this year as part of the Inflation Reduction Act. These changes apply to all of our Medicare Advantage plans.
If you collect co-insurance from a member on the date of service, and the member pays more than the adjusted co-insurance for a Part B rebatable drug, you may have to issue a refund to that member. Therefore, we strongly encourage you to bill the member after the claim has paid.
The Centers for Medicare & Medicaid Services (CMS) will publish the adjusted co-insurance for each Part B rebatable drug in the quarterly pricing files posted on the CMS website. Keep in mind the list of applicable drugs and members’ co-insurance for those drugs could change each quarter.
Some plans may also have co-insurance that is less than the co-insurance listed in these pricing files. In this scenario, members will pay the lower co-insurance.
For more information on reduced drug prices, and enhanced Medicare benefits under the Inflation Reduction Act, refer to the CMS Frequently Asked Questions.
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