Transcript cms_training_partd_postmay15

Update on Prescription Drug Coverage
2006 National Medicare Training
Centers for Medicare & Medicaid Services
Presenters:
Kay Pokrzywa
Jeff Maready
May 24, 2006
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Medicare Prescription Drug Coverage
Enrollment after May 15
May 24, 2006
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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
May 24, 2006
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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
May 24, 2006
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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
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New to Extra Help
(continued)
 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
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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
May 24, 2006
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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
May 24, 2006
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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
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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
May 24, 2006
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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
May 24, 2006
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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 state’s plan
 Generally, no need to reapply for LIS
 May need to apply for LIS if beneficiary loses
deemed status
May 24, 2006
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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
• [email protected]
 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
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