Update on Prescription Drug Coverage 2006 National Medicare

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Update on Prescription Drug Coverage 2006 National Medicare Training Centers for Medicare & Medicaid

Update on Prescription Drug Coverage 2006 National Medicare Training Centers for Medicare & Medicaid Services Presenters: Kay Pokrzywa Jeff Maready May 24, 2006 1

Medicare Prescription Drug Coverage Enrollment after May 15 May 24, 2006 2

Medicare Prescription Drug Coverage Enrollment after May 15 May 24, 2006 2

New to Medicare n People newly entitled to Medicare 7 -month initial enrollment period

New to Medicare n 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 May 24, 2006 3

New to Medicare n Full Medicaid and new to Medicare Auto-enrolled in a plan

New to Medicare n 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 May 24, 2006 4

New to Medicare n New to Medicare and SSI, MSP*, or found eligible for

New to Medicare n 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 May 24, 2006 5

New to Extra Help n Already has Medicare and found eligible for extra help

New to Extra Help n Already has Medicare and found eligible for extra help after May 15 Plan will refund costs back to effective date n 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 May 24, 2006 6

New to Extra Help (continued) n Found eligible through state data Medicare Savings Programs

New to Extra Help (continued) n 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 May 24, 2006 7

New to Extra Help (continued) n Found eligible through entitlement to SSIonly or by

New to Extra Help (continued) n Found eligible through entitlement to SSIonly 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 May 24, 2006 8

Auto and Facilitated Enrollment n Plans are randomly assigned Premiums at/below regional benchmark n

Auto and Facilitated Enrollment n Plans are randomly assigned Premiums at/below regional benchmark n People already in MA plan Enrolled in MA-PD, if offered by the MA organization May 24, 2006 9

Enrollment Notices n CMS will notify people who will be enrolled in a PDP

Enrollment Notices n 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 n MA plan sends notice if enrolling member in MAPD May 24, 2006 10

Beneficiary Options 1. Enroll in plan of their choice 2. Allow auto or facilitated

Beneficiary Options 1. Enroll in plan of their choice 2. Allow auto or facilitated enrollment to take effect • At least one opportunity to change or drop coverage 3. 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 May 24, 2006 11

Enrolling for Plan Year 2007 n Annual Coordinated Election Period (AEP) November 15 –

Enrolling for Plan Year 2007 n 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 n MA Open Enrollment Period January 1 – March 31, 2007 May 24, 2006 12

Open Enrollment Limit During the MA Open Enrollment Period If coverage is Can use

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 only MA-only MAPD Original Medicare and PDP Ref: Medicare & You 2006, pg. 65 May 24, 2006 13

Annual Coordinated Election Period (AEP) n People can join, drop, or switch Prescription drug

Annual Coordinated Election Period (AEP) n People can join, drop, or switch Prescription drug plans Medicare Advantage plans with prescription drug coverage May 24, 2006 14

Extra Help Redeterminations n LIS eligibility redetermined by SSA Based on information available to

Extra Help Redeterminations n LIS eligibility redetermined by SSA Based on information available to SSA n LIS eligibility redetermined by the state Same manner and frequency as redeterminations made under the state’s plan n Generally, no need to reapply for LIS May need to apply for LIS if beneficiary loses deemed status May 24, 2006 15

Resources n Guide to Medicare's Preventive Services Publication 10110 n CMS prevention website Go

Resources n Guide to Medicare's Preventive Services Publication 10110 n CMS prevention website Go to cms. hhs. gov Click on Medicare Scroll down and click on Prevention E-mail prevention questions and suggestions • [email protected] hhs. gov n PDP Guidance Eligibility, Enrollment, and Disenrollment n Tip sheet for partners Reimbursement Guidance 4 -18 -06. qxp May 24, 2006 16

For More Information n Visit www. cms. hhs. gov n Call 1 -800 -MEDICARE

For More Information n Visit www. cms. hhs. gov n Call 1 -800 -MEDICARE n 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 May 24, 2006 17