CMS has plan to end dual enrollment in exchange plans and Medicare

CMS has told members of Congress it will contact customers who are enrolled in both Medicare and a subsidized insurance plan purchased through the Affordable Care Act (ACA) exchanges and tell them to leave their exchange plan immediately.

The announcement came in an Aug. 31 memo sent by CMS’s legislative director, Megan O’Reilly, to congressional staffers and obtained by Inside Health Policy.

As explained by O’Reilly, CMS has identified people who are both enrolled in Medicare Part A without paying a premiums or Part C and are receiving subsidies to help pay for premiums for exchange plans. The federal marketplace will send these customers a notice instructing them to end their exchange coverage.

“Other consumers in the household who are enrolled in the marketplace plan may remain on that plan,” her memo said.

For customers who do pay a premium in Part A, like Medicare Advantage customers, they’ll be allowed to keep their subsidized exchange coverage if they wish.

Not following CMS’s instructions could result in financial penalties for consumers. The notice warned that if they don’t end their marketplace coverage, they’ll “likely have to pay back all or some of the (tax credit) received for a Marketplace plan during the months the consumers were also enrolled in Medicare.”

The agency will be sending final notices to consumers dually enrolled in a marketplace plan or Medicaid later this year.