Since 2011 the Centers for Medicare & Medicaid Services (CMS) has mandated a maximum out-of-pocket (MOOP) limit for all Medicare enrollees. The MOOP establishes an annual limit to the cost-sharing (e.g., deductibles, copayments, coinsurance) amount Keystone 65 HMO and Personal Choice 65℠ PPO members have to pay out-of-pocket each year for medical services covered under Medicare Part A and Part B. The MOOP dollar amount is established annually by CMS and does not change during the course of a calendar year.

Independence identified an issue from 2014 where some Keystone 65 HMO and Personal Choice 65 PPO member claims were erroneously processed with member cost-sharing for Part A and Part B medical services and drugs when their MOOP limit was met for the year. Independence has adjusted the affected claims, and providers who collected this additional member cost-sharing should work as expeditiously as possible to refund members accordingly.

If you have any questions please contact Customer Service at 1-800-ASK-BLUE.