Important Medical Claims Information for Some Oxford NY Members: Medicare Estimation

Posted on January 3, 2020

Oxford NY to Mail Medicare Estimation Letter to Some Members

For years Oxford has not specifically required members who were Medicare eligible to have both Medicare Part A & B coverage, as of July 1, 2020 they are changing how they enforce their policy. 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.

Additionally, during the first-half of 2020, Oxford will send the letter to any new enrollees since the initial mailing who meet the criteria outlined above, as well as any members who have since become eligible by age for Medicare Part A.

We have been trying to clarify several things with Oxford and had been holding off in sending this email while we were trying to obtain this information. We will continue to communicate additional information to you as we receive it from Oxford.

Click here for a sample of the letter.