SUBJECT:
MEDICARE PART D OPEN ENROLLMENT AND LOSS OF ELIGIBILITY FOR LOW INCOME SUBSIDY
DISCUSSION:
The purpose of this memorandum is to provide information regarding:
- open enrollment for Medicare Part D for 2007;
- deemed eligibility for low income subsidy;
- loss of eligibility for low income subsidy; and
- role of eligibility specialists.
Refer to memorandum IM-65 dated 6/13/05 for more information regarding Medicare Part D prescription drug coverage and low income subsidy.
Open Enrollment for Medicare Part D for 2007
The annual open enrollment period for Medicare prescription drug plans for 2007 begins on November 15, 2006, and ends December 31, 2006. Most beneficiaries who are satisfied with their current Medicare prescription drug coverage will not have to take any action during open enrollment, but those who wish to make a change will have options. If no changes are made, beneficiaries will continue under their current plans for 2007, unless their current plans are not offered in 2007.
On October 1, 2006, Medicare Part D drug plans began sending informational materials to all Medicare beneficiaries. Beneficiaries whose 2006 Medicare Part D prescription drug plans are not offered in 2007 are being notified by their plans. Medicaid recipients whose plans are terminating who do not choose a new plan by December 31, 2006, will be auto enrolled in a plan. Beneficiaries who want to review options will have access to help from several sources, including:
- The Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778);
- The SSA website at www.socialsecurity.gov/prescriptionhelp/;
- 1-800-Medicare (1-800-633-4227);
- Medicare's website at www.Medicare.gov;
- The Medicare & You 2007 handbook, the annual handbook that explains Medicare coverage, which beneficiaries will receive in October; and
- Community Leaders Assisting the Insured of Missouri (CLAIM) Program at 1-800-390-3330 or their website at www.missouriclaim.org.
Deemed Eligibility for Low Income Subsidy
The Social Security Administration (SSA) refers to the low income subsidy as “extra help”. The low income subsidy provides extra help to individuals with limited income and resources in paying for prescription drugs. Recipients who are receiving Medicare and Medicaid, QMB, SLMB, QI-1 (SLMB-2) or SSI are deemed eligible to receive the subsidy.
In August 2006, The Centers for Medicare & Medicaid Services (CMS) began the process to determine which beneficiaries are deemed eligible for low income subsidy for 2007. This deeming process is based on the July 2006 State data files. Individuals appearing on the July State data files are deemed eligible for the low income subsidy for the calendar year of 2007. Individuals appearing on the State file match after July 2006 will also be deemed eligible from the earliest month of reported dual eligibility through December 31, 2007.
Individuals deemed eligible for the low income subsidy for 2007 may have a change in their co-pay status for their Medicare Part D prescription plan if there has been a change in their income or resources based on information received from State data files and SSA. In early October the Centers for Medicare & Medicaid Services will be mailing notices to all deemed eligible beneficiaries whose co-pay status is changing for 2007.
In addition, some beneficiaries who are deemed eligible for the low income subsidy may have a change in their prescription plan due to an increase in premium on their current plan. These beneficiaries may be reassigned to a plan that has a lower premium. CMS will send a notice during the week of October 30 to all beneficiaries who need reassignment. If the beneficiary has a question concerning this notice, please refer him or her to 1-800-MEDICARE or www.Medicare.gov. For additional information and resources for low income subsidy refer to the attached benefit fact sheet.
Loss of Eligibility for Low Income Subsidy
Beneficiaries previously deemed eligible for the low income subsidy for 2006 who did not appear on the July 2006 State data files were not deemed eligible for the low income subsidy for the 2007 calendar year. Their eligibility for the low income subsidy will end on December 31, 2006, unless they meet their Medicaid Spenddown or are approved for QMB, SLMB, QI-1 (SLMB-2) or SSI.
In September CMS mailed the attached notice to all beneficiaries who will be losing their deemed eligible status for low income subsidy as of December 31, 2006. An application for the low income subsidy along with a postage paid envelope was included with this notice so that individuals losing their deemed eligible status can apply directly to SSA to receive the low income subsidy after December 31, 2006.
Role of Eligibility Specialists
County Offices will receive a report of all dual eligible individuals who received a notification of their loss of eligibility for the low income subsidy. At next contact with these individuals, eligibility specialists should encourage them to apply for “extra help” with Medicare Part D. Individuals may come to the local Family Support Division (FSD) office to inquire or apply for low income subsidy or to inquire about the notices they received about their prescription drug plans. If the individual brings his/her application to the county office, staff must assist the individual in completing the application. Refer individuals with questions to the resources provided in this memorandum.
Refer to the FSD Intranet Medicare Part D Information Page for additional information and resources for beneficiaries. In addition, staff must screen individuals for eligibility for other programs including Medical Assistance, QMB, SLMB and SLMB-2.
NECESSARY ACTION:
- Share this memorandum with all appropriate staff.
- Review the report of Individuals No Longer Deemed Eligible for Low Income Subsidy and encourage these individuals to apply for “extra help”.
- Refer individuals with inquiries concerning the Medicare Prescription Drug Plan to resources provided in this memorandum for help.
- Screen individuals for other types of assistance.
ER/SD
ATTACHMENTS:
CMS' Loss of LIS Notice 092006 
Benefit Fact Sheet Changes LIS 07