2009 Memorandums

IM-#75      09/26/09

P.O. BOX 2320


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 2010

Open enrollment for Medicare Part D for 2010 will begin on November 15, 2009, and ends on December 31, 2009. 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, 2009, participants will continue under their current plans for 2010, unless their current plans are not offered in 2010. 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 2010 if the premium for their current plan is rising to more than $1 in 2010.

Participants whose 2009 Medicare Part D prescription drug plans are not offered in 2010 will be notified by the Centers for Medicare and Medicaid Services (CMS) by a blue colored letter that will be sent to participants in early November. MO HealthNet participants whose plans are terminating who do not choose a new plan by December 31, 2009, will be auto enrolled in a new plan. Participants who want to choose their own plans should compare new 2010 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:

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 July 2009, the Centers for Medicare & Medicaid Services (CMS) began the process to determine which participants are deemed eligible for low income subsidy for 2010. This deeming process is based on the July 2009 State data files. Participants appearing on the July State data files are deemed eligible for the low income subsidy for the calendar year of 2010.

NOTE: Participants appearing on the State file match after July 2009 will also be deemed eligible from the earliest month of reported dual eligibility through December 31, 2010.

Participants deemed eligible for the low income subsidy for 2010 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 October CMS will mail orange colored notices to all deemed eligible participants whose co-pay status is changing for 2010. Participants may choose to not respond and coverage will continue under the current plan in 2010 with the higher co-pay amounts or the participant can choose a new plan for 2010.

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 will send a blue colored notice in early November, 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, 2010, unless they enroll in a new plan by December 31, 2009.

Some LIS participants chose to be enrolled in a plan with a higher premium. If their premium is rising in 2010, will be sent a tan letter by CMS during the first week of November. 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, 2009. 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 2010.

Loss of eligibility for low income subsidy

Participants previously deemed eligible for the low income subsidy for 2009 that did not appear on the July 2009 State data files were not deemed eligible for the low income subsidy for the 2010 calendar year. Their eligibility for the low income subsidy will end on December 31, 2009, 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, 2009. 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, 2009. In the event that an individual who CMS had notified as losing his or her LIS in 2010 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

Eligibility specialists should refer participants with questions on enrolling in a prescription drug plan or how to qualify for “extra help” with their Medicare Part D plan premiums to the resources provided above.



2009 Memorandums