Medicare Update for the California Medicare Coalition

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Medicare Updatefor theCalifornia
MedicareCoalition

• Frank Van Nostrand
• Public Affairs Specialist October 4, 2006

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Drug Coverage Enrollment
Data as of 06.11.06
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Wealthier Seniors will PayMore for their Part B
in 2007
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Income Related Monthly Adjustment
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Basic Coverage in 2007Beneficiary pays an
estimated 288 in premium (24 monthly)
0
265
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Are the Resource Limits for the Extra Help
program going up?

• Yes!
• But we dont know how much yet..
• They will be announced when the Social Security
  COLA is announced.

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Collection of Part D Premiums

• Early August Checks mailed to 230,000
  beneficiaries
• August 18 Letter - Acknowledges Error
• August 31 2nd Letter Asks for Refund
• September 28 Federal Court orders a halt to
  collection
• Overpaid individuals may request Waiver

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Extra HelpRedeterminationof Eligibility
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4 Types of Redeterminations

• L1026
• Subsidy Changing Event
• Redetermination following report of
• other event
• Cyclical redeterminations

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L1026 Redetermination

• Started August 2006
• Eligible for Extra Help 01/06 04/06
• Only one L1026 redet per person/couple

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4 step procedure

• SSA-L1026 is mailed to individual
• If no changes, no action required
• If changes, return the form attached to the
  letter
• We will review and send out an SSA-1026- REDE
  with income/resource summary.
• Must be returned within 30 days
• 30 day extension may be requested

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4 step procedure

• If returned form shows a subsidy changing event
  
• case is sent to the field office
• If no subsidy changing event
• subject to verification
• Any changes will be effective
• January of following year

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Exceptions to the L-1026

• Individual reports an SCE
• We will send an SSA-1026-SCE
• Individual reports another event
• We will send an SSA-1026-REDE
• A match of agency data indicates the current
  subsidy amount may be incorrect

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Subsidy Changing Event

• Marriage
• Death of living-with spouse
• Divorce of living-with spouse
• Annulment of living-with spouse
• Separation of living-with spouse
• Resumption of living together with previously
  separated spouse

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SCE is reported

• We will send an SSA-1026-SCE
• If form is returned within 90 days, we will
• Redetermine the subsidy amount, or
• Terminate the subsidy, or
• Determine that no change is warranted
• If form is not returned within 90 days
• Subsidy is terminated
• Change is effective the month after the report of
  SCE

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Report of Other Event

• If other event is reported before August
• SSA-1026-REDE mailed out with cyclical
  redeterminations
• If other event is reported between
  August-December
• SSA-1026-REDE will be mailed immediately
• Any changes will be effective January of the
  following year

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Cyclical Redeterminations

• Selected once a year
• First year eligibles will receive a L1026
• Only a portion of other eligibles will be
  selected
• We will mail an SSA-1026-REDE
• Must be returned within 30 days
• 30 day extension may be requested

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Cyclical Redeterminations

• If returned form shows a subsidy changing event
  
• continuing subsidy will be determined
• change effective month after report
• If no subsidy changing event
• subject to verification
• any change in subsidy effective January of next
  year

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Thats All Folks!!