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Please scroll down to the bottom of the page for downloadable materials and helpful links. Please note the number in bracket next to a bold item in the page content corresponds to the downloadable item or link at the bottom of the page. Everyone with Medicare, regardless of income, health status, or prescription drugs used, can get prescription drug coverage. This page provides information on enrollment policies and procedures for State agencies that help people with Medicare that are also beneficiaries of various state programs (like Medicaid, SPAPs, or MSP programs). Enrollment Guidance Provided to Plans by CMS: Guidance on eligibility, enrollment and disenrollment is provided to plans via the document {1} PDP Guidance: Eligibility, Enrollment and Disenrollment (auto- and facilitated-enrollment details are in Section 30.1.4) and the {2} Medicare Managed Care Manual: Chapter 2, "Medicare Advantage Enrollment and Disenrollment" (auto- and facilitated enrollment details are in Section 40.1.6). {3} Enrollment Numbers: CMS provides information on the number of people with prescription drug coverage (including breakouts of Part D and Medicare Advantage) by county and state, as well as enrollment information about the low-income subsidy. After clicking the link below, go to the bottom of that page and click on "2008 Enrollment Information." Enrollment Periods: People who are eligible for Medicare Part D must enroll during an enrollment period. People can first enroll upon becoming eligible for Medicare during their initial enrollment period (IEP) when they are first eligible for Medicare Part D. During this period, many people receive a "Welcome to Medicare" package for new Medicare beneficiaries, which briefly details information about Part D. Also, every year people can change their coverage during the Medicare fall open enrollment period (also known as the annual enrollment period" or AEP). This is the time for all individuals to review their health care and drug coverage and make changes if they choose. However, there are certain situations that are not covered by these enrollment periods that are detailed below and in the publication {4} "Understanding Medicare Enrollment Periods" (CMS Pub No. 11219-P) which can be accessed at the bottom of this page. Special Enrollment Periods (SEP): In certain situations, people with Medicare may be eligible for a Special Enrollment Period to join a plan that provides Medicare prescription drug coverage, or switch to a different plan. Such situations include having Medicaid, getting extra help, or moving. A SEP is a period of time when an individual can enroll in or switch plans outside of the annual enrollment period (November 15th-December 31st). Late Enrollment Periods (LEP): Generally, Medicare beneficiaries who are qualified to join a prescription drug plan, or Part D, but choose not to enroll during their initial enrollment period, may be subject to a late enrollment penalty. These fees were intended to encourage Medicare beneficiaries to sign up for a drug coverage plan when they first become eligible, but may cause some low-income beneficiaries to avoid seeking coverage. However, CMS offers protection against the LEP so that beneficiaries who qualify for the LIS may enroll in the drug benefit without penalty through December 31, 2008. Protections for Beneficiaries: CMS recognized the potential impact on Medicaid beneficiaries who do not choose a plan and developed a process to automatically enroll these beneficiaries into a PDP. CMS will auto-enroll or facilitate enrollment for all those who are eligible for a low-income subsidy (LIS) so that they will have prescription drug coverage. Auto-enrollment is the process for full-benefit dual eligibles; facilitated enrollment is the process for others who LIS eligible. The processes are essentially the same, but the effective date for each differs. Beneficiaries who have already enrolled in a plan or who have opted out of enrollment will not be enrolled by CMS. CMS continues to contract with WellPoint to administer the {5} Point-of-Sale Facilitated Enrollment (POS FE) process, which is designed to provide seamless drug coverage for Medicare/Medicaid dual eligible and other LIS eligible beneficiaries in 2008. Due to missing information of time lags between the identification of an individual as a dual eligible or other LIS eligible and his/her assignment to a Part D prescription drug plan, an individual may present at a pharmacy before a plan enrollment has been recorded in CMS' systems. The POS FE process provides a safety net for dual eligible and other LIS eligible beneficiaries who are not yet enrolled in a Part D prescription drug plan so that they can obtain immediate prescription drug coverage at the pharmacy.
Page Last Modified: 08/26/2008 1:12:40 PM
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