| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | MEDICARE PART D, OPEN ENROLLMENT, AND ELIGIBILITY FOR LOW INCOME SUBSIDY |
DISCUSSION:
In January 2006, people with Medicare became eligible for Medicare Part D prescription drug coverage. People who receive both Medicare and MO HealthNet are referred to as dual eligible. Dual eligible participants are eligible for Social Security Administration's (SSA) low income subsidy to help pay for their Medicare Part D. MO HealthNet does not pay for a dual eligible participant's prescription drugs that are covered by Medicare Part D.
Individuals can enroll in Medicare Part D prescription drug plans up to three months before and three months after becoming eligible for Medicare. A participant who has dual eligibility for MO HealthNet and Medicare Part D can change prescription drug plans at any time. However, an individual who is not eligible for both MO HealthNet and Medicare Part D can only change plans outside of open enrollment under certain circumstances. Generally, if a participant joins a prescription drug plan, the enrollment continues for the calendar year.
This memorandum provides information regarding:
- open enrollment for Medicare Part D for 2008;
- deemed eligibility for low income subsidy;
- loss of eligibility for low income subsidy; and
- role of eligibility specialists.
Open Enrollment for Medicare Part D for 2008
Open enrollment for Medicare Part D for 2008 began on November 15, 2007, and ends on December 31, 2007. Most participants 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 or no action is taken by December 31, 2007, participants will continue under their current plans for 2008, unless their current plans are not offered in 2008. Due to changes in their Part D prescription drug plans, some participants will experience an increase in their premium if they stay with their current plan and other low income subsidy (LIS) eligible participants will be reassigned to a new plan in 2008 if the premium for their current plan is rising to more than $1 in 2008.
Participants whose 2007 Medicare Part D prescription drug plans are not offered in 2008 were notified by the Centers for Medicare and Medicaid Services (CMS) by a blue colored letter sent to participants between October 29, 2007, and November 2, 2007. MO HealthNet participants whose plans are terminating who do not choose a new plan by December 31, 2007, will be auto enrolled in a new plan. Participants who want to choose their own plans should compare new 2008 plans with others and make a choice as to which plan best fits their needs. Participants 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 2008 handbook, the annual handbook that explains Medicare coverage, which beneficiaries received 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. Participants who are receiving Medicare and MO HealthNet, QMB, SLMB, QI-1 (SLMB-2) or SSI are deemed eligible to receive the subsidy.
In August 2007, the Centers for Medicare & Medicaid Services (CMS) began the process to determine which participants are deemed eligible for low income subsidy for 2008. This deeming process is based on the July 2007 State data files. Participants appearing on the July State data files are deemed eligible for the low income subsidy for the calendar year of 2008.
NOTE: Participants appearing on the State file match after July 2007 will also be deemed eligible from the earliest month of reported dual eligibility through December 31, 2008.
Participants deemed eligible for the low income subsidy for 2008 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 CMS mailed orange colored notices to all deemed eligible participants whose co-pay status is changing for 2008. Participants may choose to not respond and coverage will continue under the current plan in 2008 with the higher co-pay amounts or the participant can choose a new plan for 2008.
In addition, some participants 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. CMS sent a blue colored notice between October 29 and November 2, 2007, to all participants whose premium will be increasing by more than $1. Participants who did not choose a Part D plan with a higher premium will be reassigned and auto enrolled in a new plan with a lower premium as of January 1, 2008, unless they enroll in a new plan by December 31, 2007.
Some LIS participants chose to be enrolled in a plan with a higher premium. If their premium is rising in 2008, they were sent a tan letter by CMS in late October. The participant has the option of continuing with their chosen plan and paying the higher amount or they can choose to enroll in a new plan by December 31, 2007. If the participant does not respond, eligibility will continue under their current plan and they will be responsible to pay the increased premium amount in 2008.
Loss of eligibility for low income subsidy
Participants previously deemed eligible for the low income subsidy for 2007 that did not appear on the July 2007 State data files were not deemed eligible for the low income subsidy for the 2008 calendar year. Their eligibility for the low income subsidy will end on December 31, 2007, unless they meet their MO HealthNet spenddown or are approved for QMB, SLMB, QI-1 (SLMB-2) or SSI.
In September CMS mailed grey colored notices to all participants who will lose their deemed eligible status for low income subsidy as of December 31, 2007. 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, 2007. In the event that an individual who CMS had notified as losing his or her LIS in 2008 becomes newly eligible for MO HealthNet or SSI in future months, CMS will mail them a new letter informing them that they now automatically qualify for LIS. The notice will include information on how to enroll in Medicare Prescription Drug (Part D) Plan.
Role of Eligibility Specialists
County offices will receive a report of all participants who received a notification of their loss of eligibility for low income subsidy (LIS). Eligibility specialists should encourage theses participants to apply for “extra help” with their Medicare Part D at the next contact.
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 participants to apply for “extra help”.
- Refer participants with questions concerning Medicare Part D to the resources provided in this memorandum.