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3. 3 Y e s The initial enrollment period for people with Medicare and some Medicaid is the same as for other enrollees. If these individuals do not join a plan by the end of the open enrollment period (May 15, 2006), they will be auto-enrolled into a randomly selected prescription drug plan with coverage effective June 1, 2006. Individuals will be able to submit applications online if their plan participates in the CMS Online Enrollment Center. Medicare Savings Program participants receive assistance paying their Medicare Part A and/or Part B premiums, deductibles, 4 If they join a plan between November 15 and December 31, 2005 coverage will be effective January 1, 2006. If they select a plan anytime after December 31, 2005 coverage will be effective the first day of the following month (e.g., if a health plan is selected on January 15, 2006 then coverage will be effective February 1, 2006.) 7 Plan must notify individual within 7 business days after receipt of eligibility confirmation from CMS. 5 Plans must process enrollment applications within 30 days of receipt (Source: Medicare Managed Care Manual - Chapter 19). 8 Evidence of Coverage could be a member ID card, an enrollment letter or another form of proof of coverage. 9 If an individual did not select a plan prior to May 15, 2006 and is dissatisfied with the plan in which CMS auto-assigned them, the person may to select an alternate plan between May 16, 2006 and May 31, 2006. If they join a plan during this period, coverage will be effective June 1, 2006. If they do not select an alternate plan they will remain enrolled in and covered by the plan to which CMS assigned them, so as to avoid a lack of coverage. 1 2, 3 6 Individuals with Medicare and some Medicaid benefits qualify for Extra Help paying their premium, therefore, if a person joins a plan with a premium equal to or less than the Medicare subsidy amount, they will not have to pay a premium. 10 Individuals who have Medicare and some Medicaid benefits are entitled to a Special Enrollment Period, this designation allows these individuals to switch in and out of MA plans at any time. Process to Enroll in a Medicare Prescription Drug Plan for People with Medicare and Some Medicaid Benefits (Partial-Benefit Dual Eligibles), SSI-only Recipients, and Individuals Who Are Approved for Extra Help (People with Some Medicaid Benefits and Medicare refers to those who participate in a Medicare Savings Program. 1 ) Individual YES NO YES Individual is Randomly Assigned to a Plan November 15, 2005 through May 15, 2006 4 Plan Sends Application for Enrollment to Potential Member CMS Notifies Individual Individual’s Application for Enrollment Arrives: Complete & Return to Plan May 16, 2006 through May 31, 2006 Plan Processes Application 5,6 Individual Provides Evidence of Coverage Prior To Effective Date 8 8 Plan Checks Eligibility with CMS Plan Notifies & Enrolls Individual 7 June 1, 2006 October 2005 Individual to Request an Application from Selected Plan To Enroll 3 NO Individual Chose a Plan to Join? Individual is Eligible? Individual Is Satisfied with CMS-assigned Plan? Plan Notifies Individual 7 NO Individual May Begin Using Plan on Effective Date 9 Individual May Begin Using Plan on Effective Date 9 Medicare & You Handbook Arrives in the Mail Individual May Call 1-800-MEDICARE or Use www.medicare.gov to Compare Plans 2 The boxes outlined in purple signify those responsibilities and actions specific to individuals, who will enroll, or be enrolled in a Medicare Prescription Drug Coverage plan. The boxes outlined in orange represent the responsibilities and actions of organizations involved with Medicare Prescription Drug Coverage, such as health plans, CMS, SSA, and other state and local agencies. 1-800-MEDICARE  Disenroll from Medicare Prescription drug coverage  Opt-out of an auto-enrollment  Identify type of enrollment (e.g., Plan, Auto-enrolled, Facilitated)  Determine PDP and MA PD enrollment information (E.g., plan name and effective date)  Verify and individual’s automatic eligibility for Extra Help to cover drug plan costs  Assess an Individual’s employer plan receives a Medicare subsidy  Verify an individual’s enrollment status in a plan www.medicare.gov  Signup for participating plans using the Online Enrollment Center  Determine whether to apply for Extra Help using the self screen tool  Compare plan prices and benefits using the Medicare Prescription Drug Plan Finder Web Tool State Health Insurance Assistance Programs (SHIPs)  Receive face-to-face counseling and assistance to select the right PDP or MA PD plan  Obtain printed materials with specific information  Attend education sessions Community based Enrollment Networks  Obtain educational materials and direction on where to go for additional help People who have Medicare and some Medicaid benefits, SSI recipients, and individuals who apply and are approved for Extra Help are able to switch plans only one time during the remainder of 2006. In all future years, individuals may switch plans during the annual election period (November 15 through December 31). 10 More Information & Resources for People Who Have Medicare Individual Receives Letter from Medicare Declaring Eligibility for Extra Help with Drug Plan Costs and Details of Facilitated Enrollment Process June 2005

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