Many safety net patients may have faced changes in Medicare Part D during the open enrolllment period that ended December 31, 2006. The Centers for Medicare & Medicaid Services have notified affected individuals, which includes Medicare beneficiaries who are:
| Situation: Your patient received a letter from Medicare, printed on blue paper, informing them that they are being reassigned to a new Prescription Drug Plan. |
| Reason: The plan the patient was using in 2006, now in 2007, does not have premiums at or below the LIS amount for their state.
Medicare won't re-assign LIS beneficiaries who switched to different plans on their own. Medicare also won't re-assign beneficiaries who were enrolled in a plan by authorized representatives such as State Pharmaceutical Assistance Programs (SPAPs). |
Response: The patient may want to seek counseling from the
State Health Insurance Assistance Programto be sure the new plan they have been reassigned to best meets their needs. |
| Situation:
Your patient received a letter from Medicare, in partnership with the Social Security Administration, telling them that their eligibility status for the LIS has changed. The letter the patient received includes a new application for the LIS with a postage paid envelope. |
| Reason: Approximately 630,000 people who were automatically eligible for extra help (the Low Income Subsidy) last year , no longer automatically qualify for extra help in 2007 due to a change in status (e.g. they may no longer qualify for Medicaid) and need to find out whether they are still eligible by submitting an LIS application. |
Response: Encourage your patient to apply for the Low Income Subsidy (LIS) to help them with their premiums, copays and deductibles. Patients may find out if they are eligible for and apply for the Low Income Subsidy (LIS) on-line. |
Situation: Your patient may be eligible for the Low Income Subsidy (LIS) but has not applied and may be missing out on receiving benefits they are entitled to. |
| Reason: Many beneficiaries may not know about the benefits they may be eligible for and may need assistance in applying. People may also believe their income is not low enough to qualify for the Low Income Subsidy (LIS) or do not want to ask for the “extra help” in paying for their prescription drugs. |
Response: Encourage limited-income beneficiaries to apply for extra help and to enroll in a Prescription Drug Plan. Patients may apply for the Low Income Subsidy (LIS) on-line. |
| Situation:
Your patient may be eligible to enroll in a Medicare Part D plan as a new enrollee but has not done so yet. |
| Reason: Part D Enrollment for 2007 Enrollment in Medicare drug plans is voluntary for most beneficiaries, with the exception of dual eligibles and certain low-income beneficiaries who are automatically enrolled if they do not choose a plan on their own. |
Response: Encourage your patient to compare their prescription drug coverage options because unless beneficiaries have coverage that is at least as good as standard Part D coverage, they face a penalty equal to 1% of the national average monthly premium ($27.35 in 2007) for each month they delay enrollment after the open enrollment period (November 15 – December 31, 2006). |
