Medicare Grace Periods for I-SNBC & MSHO

Purpose:
To help Hub staff recognize when a person might be in a Medicare grace period for an Integrated SNBC (I-SNBC) or MSHO plan, understand why system information may not match, and know how to verify and escalate appropriately.

Q&A

Q: A caller says their pharmacy told them they still have coverage through their MSHO or I-SNBC plan, but MN–ITS and MMIS both show Medical Assistance ended. How can that be?
A:
This can happen when the person is in a Medicare grace period.
During this time, Medicare still shows the plan as active even though MMIS and MN-ITS show that it ended. The grace period allows temporary continued coverage—mainly for prescriptions—while systems update and the person transitions to new coverage.

To confirm what’s happening:

1. Verify benefits:
   • In MNITS: See if Medical Assistance or SNBC enrollment is active or has ended.
   • If you don’t see current coverage, start a BLU chat and ask to check:
     • The end date of MA or SNBC coverage, and
     • The SNBC disenrollment reason
       • If the disenrollment reason is EE, it usually means the person qualifies for a grace period.
2. If BLU confirms MA ended and the caller says the pharmacy still sees the plan as active:
   • Start a Medicare chat (MAP) to verify whether the MSHO or Integrated SNBC plan is still showing as active with Medicare.
   • If Medicare still shows it active, the person is in a grace period—and Medicare is the source of truth during this transition.

Q: What is a Medicare grace period?
A:
A grace period is a temporary extension of coverage for people leaving an MSHO or Integrated SNBC plan.

• It lasts up to 90 days or until the person chooses a new Part D plan.
• It ensures people don’t lose prescription coverage while transitioning between plans or after losing MA.
• MMIS may show the plan ended, but Medicare continues to show it as active during this period.

Learn more:

• Medicare Prescription Drug Coverage (Part D)
• MSHO overview – DHS
• SNBC overview – DHS

Q: The pharmacy says the plan has terminated, but Medicare still shows it as active. What should I do?
A:
Conduct a Medicare chat with MAP:

• Medicare still lists the plan as active, and
• The pharmacy’s rejection code says plan terminated (not prior authorization, refill too soon, etc.),

→ Escalate to MAP and include:

• Confirmation that Medicare still shows the plan active, and
• The pharmacy’s report that the plan is rejecting as terminated.

Tier 3 will contact the plan to update its files to match Medicare’s records. Once the plan’s data is corrected, the pharmacy can bill the plan again through the end of the current month.

Q: What coverage applies during the grace period?
A:
It depends on whether the person still has MA:

• If MA ended:
  • They have Original Medicare (Parts A and B) and Part D only.
  • Deductibles, copays, and over-the-counter items are not covered.
• If MA continues:
  • They keep all MSHO/Integrated SNBC benefits during the grace period.
  • It’s normal for MMIS or the plan to show MSC+ or non-integrated SNBC while Medicare still lists MSHO/I-SNBC as active.

Q: Example from blueplus
A:
Yes.
For members who lose MA eligibility:

• They may have a 90-day grace period.
• Coverage continues for Medicare-covered services, Care Coordination, and MSHO supplemental benefits.
• In Mn-ITS they appear terminated, but remain on the plan’s roster with a “GRACE PERIOD ENDING MM-DD-YYYY” flag.

Reference: Blue Plus MSHO Provider Resources

Internal Notes

• Hub staff will likely first notice this when systems show MA ended but the person reports active coverage.
• The grace period applies only to MSHO and Integrated SNBC plans.