Oxford Health Plans & Medicare Part B 3/23/2020

Effective for 2020- Oxford is changing its contract to coordinate benefits with Medicare Parts A & B, starting July 1, 2020.  If you are an employee and are currently eligible for Medicare, enrolled in Part A but not enrolled in Part B, this could affect you.  Please be sure to review the details of this below and call Oxford if you have any questions about how the coordination of benefits works with Medicare.  (this is specific for employees already eligible for Medicare A & B.  If you are newly eligible, you have an initial enrollment period, based on your date of birth.

Why is this important now?  Because Part B annual open enrollment for those already eligible for Medicare ends on March 31, 2020 for a July 1, 2020, effective date.

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

The letter informs these members that, beginning July 1, 2020, Oxford will apply Medicare Estimation when processing their claims. This reduces the amount of their payment by the amount Medicare would have paid if the eligible member was enrolled in Part B coverage. The letter also reminds members about the upcoming open enrollment period for Medicare Part B coverage, January 1, 2020 through March 31, 2020.

This coverage change will have widespread effects however the most critical is for employer groups between 1-20 employees as under most circumstances those group policies are set up with Medicare as the primary payer for Medicare-eligible members. Today claims would be paid in the same way by Oxford, regardless of whether the member has Medicare Part B or not, and this will no longer be the case after July 1, 2020. Any payment Oxford makes for those members would be reduced, assuming that Medicare has already paid part of this claim.

Find more information about who pays first at Medicare Who Pays First


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