Medical Highlights
How many follow up visits are offered to the members in 2027, for HHV?
This benefit allows for up to two clinically necessary follow up visits per member per year when additional evaluation or intervention is warranted following an initial
What is the mailing timeline for Post-ANOC negative highlights?
Mailing timeline: In-hand 11/12 - 11/21
What is LIS?
Low-Income Subsidy (LIS), also called Extra Help, is a federal program for Medicare beneficiaries who have limited income and financial resources.
What does VPC mean?
Voluntary Plan Change (VPC): The current (2026) plan will remain active.
What was the increase amount for the CMS standard deductible?
The CMS standard deductible increases $85 for 2026.
What is the new transportation some plans will use in 2027?
Some plans will now use NationsTransport
What will the cost of the GLP-1 bridge program be in 2027?
$50 flat copay for eligible members, prior authorization required
What are LIS beneficiaries not subject to?
Part D late enrollment penalties
How many counties is Aetna expanding to in 2027?
Expanding:
Into 44 new counties
What 3 things must the member have to qualify for SSBCI in 2027?
o qualify for SSBCI benefits, members must meet all three requirements:
Have one or more chronic condition(s) that are medically complex and life-threatening, or that greatly limit overall health or ability to function; and
Are at high risk of going to the hospital or having other serious health problems; and
Require a high level of care coordination
Additionally, each SSBCI benefit must have a reasonable expectation of improving or maintaining a member’s health or overall function.
How many of our plans will offer OTC in 2027?
Only 18 plans will offer this benefit (In 2026 we had 56 plans that offered the benefit.).
What state will still have access to MOD and specialty pharmacy access in 2027?
Arkansas
What changes were made to the LIS levels for 2027?
Level 1- generic/all others went up
Level 2- generic/all others went up
Level3- no changes were made
What is specifically going on in the state of Ohio for 2027 AEP?
What 2027 change was made for companion care?
The benefit structure has changed from yearly to quarterly. In 2026 we offered 60 - 430 hours of companion care per year. In 2027 we will now offer up to 50 hours per calendar quarter, with no rollover into the next quarter or next plan year.
How many hours of in-home support personal care may our members recieve in 2027?
Per market selection, members may receive 40, 60, 80, or 100 hours of support per year.
What is the maximum deductible for all DSNP plans in 2027?
maximum $700 deductible
What qualifies you to be automatically enrolled into LIS?
How many new CSNP plans have been added for 2027?
Renewed 40 plans + added 35 new plans
What are the SEPs for member who received a non-renewal?
What state will be offering unlimited transportation with a diagnoses of ESRD?
This benefit will allow New Jersey members
What is the top positive change for the formulary in 2027?
Vraylar (T5→T3)
As of what year is there no longer partial LIS benefits?
2024.
How many CSNP plans include HVP bonus?
*** 41 of 75 CSNP plans include the HVP bonus
What is the standard disclosure when transferring to telesales?
Remember: Members must verbally agree to being transferred to Telesales, and you must provide the standard disclosures when transferring to Telesales (e.g., "you will be transferred to a licensed sales representative").