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.