CMS Puts Sanctions on Cigna Medicare Advantage Plans

Sanctions Could Affect New Medicare Beneficiaries

Doctor talking to senior man
UpperCut Images/Getty Images

If you have a Cigna Medicare Advantage or Part D plan, you may want to take a close look at your options. The Centers for Medicare and Medicaid (CMS) has put sanctions on the company for what it considers to be "systemic failures".

CMS Regulates Medicare Advantage

You have two choices when it comes to Medicare. You can sign up for Original Medicare (Part A and Part B) through the government with an optional Part D plan or you can choose a Medicare Advantage (Part C) plan with or without prescription drug coverage.

Medicare Advantage plans have the option to offer additional services not covered by Original Medicare.

Medicare Advantage and Part D plans are not actually run by the U.S. government. They are offered by private insurance companies who agree to terms set by CMS. In doing so, these insurers agree to establish plans that cover everything that Medicare do and to hold their plans to a standard that addresses customer service and other protections to the consumer.

What Cigna Medicare Advantage and Part D Plans Did Wrong

The Medicare Parts C and D Oversight and Enforcement Group has been organized to assure that these plans hold to their end of the bargain with CMS. An audit was conducted in October 2015 and in January 2016, Cigna was notified that their current model "poses a serious threat to the health and safety of Medicare beneficiaries".

The insurer was found to be deficient in their grievances and appeals processes.

CMS noted issues where Cigna Medicare Advantage plans did not seek information to support appeals when appropriate, frequently misclassified cases, repeatedly failed to meet deadlines and prematurely closed cases. As for their Part D plan, Cigna improperly completed prior authorizations, failed to provide transition supplies of medications when indicated and was noncompliant in administering its CMS-approved formulary.

CMS Sanctions and How They Affect You

Altogether, CMS identified issues that affected patient access to needed tests, treatments and medications, resulting in substandard care. This resulted in unnecessary risk to these patients.

As a result, enrollment and marketing to new Medicare beneficiaries are suspended until Cigna can rectify these issues in a way that is satisfactory to CMS. However, people currently on these plans -- 543,500 Medicare Advantage and more than 1.1 million Part D enrollees -- can continue to be on them if they so choose. If they ave been affected by the issues stated, they may change their plans without waiting for the annual Open Enrollment Period, October 15 to December 7.

Anthem and Cigna Join Forces

Anthem plans to merge with Cigna with the deal expected to be completed in the second half of 2016. Anthem intends to continue the acquisition despite Cigna's current Medicare Advantage and Part D issues.

Let us hope these issues are corrected as soon as possible. We need more reliable health plans on the market. In the meantime, if you have been negatively affected by a Cigna plan, seek an alternative.


Anthem, Inc. About the Transaction. Accessed February 8, 2016.

Centers for Medicare & Medicaid Services. Cigna Sanction. Published January 21, 2016.

Zachary Tracer. Cigna Banned from Medicare Sales for 'Systemic Failures'. Bloomberg Business. Published January 22, 2016.

Continue Reading