Medicare Prescription Drug Plans

1
Update on Prescription Drug Coverage
2006 National Medicare Training Centers for
Medicare Medicaid Services Presenters
Kay Pokrzywa Jeff Maready
2

• Medicare Prescription Drug Coverage
• Enrollment after May 15

3
New to Medicare

• People newly entitled to Medicare
• 7-month initial enrollment period for Part D
• 3 months before month of eligibility
• Coverage begins on date eligible
• Month of eligibility
• Coverage begins first of the following month
• 3 months after month of eligibility
• Coverage begins first of the following month

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New to Medicare

• Full Medicaid and new to Medicare
• Auto-enrolled in a plan for coverage first day of
  Medicare entitlement unless
• Chooses own plan during first 3 months of IEP, or
• Calls 1-800-Medicare or plan and opts out of
  enrollment
• Can change plans at any time

5
New to Medicare

• New to Medicare and SSI, MSP, or found eligible
  for extra help
• Facilitated into a plan for coverage unless
• Chooses own plan during first 3 months of IEP
• Enrolled in employer plan receiving subsidy
• Calls 1-800-Medicare or plan and opts out of
  enrollment
• People with MSP can change plans at any time
• Others facilitated into a plan by CMS
• Get one SEP before end of year
• Can switch plans or disenroll

Medicare Savings Program QMB, SLMB, QI
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New to Extra Help

• Already has Medicare and found eligible for extra
  help after May 15
• Plan will refund costs back to effective date
• Found eligible through state data
• Medicaid (full dual-eligibles)
• If not in a Part D plan, auto-enrolled
• Once CMS notified by state, retroactive to the
  month of Medicaid eligibility
• Can choose own plan prior to auto-enrollment
• Can switch plans at any time

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New to Extra Help(continued)

• Found eligible through state data
• Medicare Savings Programs
• Not in Part D plan, facilitated into a plan
• Can choose own plan prior to facilitated
  enrollment
• Can switch plans at any time

8
New to Extra Help(continued)

• Found eligible through entitlement to SSI-only or
  by applying for extra help
• Currently in Part D plan
• Plan notified of LIS eligibility
• Not currently in Part D plan
• Can choose own plan prior to facilitated
  enrollment
• SEP to switch plans once before end of year
• Can switch plans or disenroll

9
Auto and Facilitated Enrollment

• Plans are randomly assigned
• Premiums at/below regional benchmark
• People already in MA plan
• Enrolled in MA-PD, if offered by the MA
  organization

10
Enrollment Notices

• CMS will notify people who will be enrolled in a
  PDP
• Auto-enrolled receive letter on yellow paper
• Facilitated receive letter on green paper
• Two versions
• Full subsidy
• Partial subsidy
• Include list of plans
• In that region
• At/below benchmark premium
• MA plan sends notice if enrolling member in MAPD

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Beneficiary Options

• Enroll in plan of their choice
• Allow auto or facilitated enrollment to take
  effect
• At least one opportunity to change or drop
  coverage
• Decline to be enrolled in a plan
• Call 1-800-Medicare or
• Call the plan named in the notice, and
• Ask to disenroll from plan AND not be enrolled
  again by Medicare

12
Enrolling for Plan Year 2007

• Annual Coordinated Election Period (AEP)
• November 15 December 31, 2006
• All people with Medicare
• Can join, drop, or switch coverage
• Effective January 1, 2007
• AEP each year
• MA Open Enrollment Period
• January 1 March 31, 2007

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Open Enrollment Limit

• During the MA Open Enrollment Period

If coverage is Can use OEP to get Cannot use OEP to get
Medicare Advantage with prescription drug coverage (MAPD) MAPD Original Medicare and PDP MA-only Original Medicare only
Medicare Advantage with no prescription drug coverage (MA-only) MA-only Original Medicare only MAPD Original Medicare and PDP
Original Medicare and a prescription drug plan (PDP) MAPD MA-only A different PDP to use with Original Medicare
Original Medicare only MA-only MAPD Original Medicare and PDP
Ref Medicare You 2006, pg. 65
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Annual Coordinated Election Period (AEP)

• People can join, drop, or switch
• Prescription drug plans
• Medicare Advantage plans
• Medicare Advantage plans with prescription drug
  coverage

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Extra Help Redeterminations

• LIS eligibility redetermined by SSA
• Based on information available to SSA
• LIS eligibility redetermined by the state
• Same manner and frequency as redeterminations
  made under the states plan
• Generally, no need to reapply for LIS
• May need to apply for LIS if beneficiary loses
  deemed status

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Resources

• Guide to Medicare's Preventive Services
• Publication 10110
• CMS prevention website
• Go to cms.hhs.gov
• Click on Medicare
• Scroll down and click on Prevention
• E-mail prevention questions and suggestions
• prevention_at_cms.hhs.gov
• PDP Guidance
• Eligibility, Enrollment, and Disenrollment
• Tip sheet for partners
• Reimbursement Guidance 4-18-06.qxp

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For More Information

• Visit www.cms.hhs.gov
• Call 1-800-MEDICARE
• Call State Health Insurance Assistance Program
  (SHIP)
• Call 1-800-MEDICARE (1-800-633-4227) for SHIP
  telephone number
• TTY users should call 1-877-486-2048