Helping People Eligible for Extra Help What You Need to Know about LIS National Medicare Training Program Audio-conference Training September 26, 2007.

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Presentation transcript:

Helping People Eligible for Extra Help What You Need to Know about LIS National Medicare Training Program Audio-conference Training September 26, 2007

2 Today’s Topics CMS strategies and objectives for 2008 Overview of prescription drug coverage People with changes in 2008 Audiences Target messages Actions Resources

3 CMS Strategies Annual enrollment period begins November 15 Year-round efforts to reach people with low-income Some will have changes for 2008 LIS eligibility Plan enrollment CMS specific focus Those potentially eligible for LIS Those with LIS who face changes in 2008 premiums July 2007 document describes our plans

4 Looking at 2008 Review and select plans during the annual enrollment period Greater number facing changes in 2008 Some face increase in premium if they remain in current plan 1.5 million will be reassigned to a new plan

5 CMS Objectives Work with partners to help people Understand coverage and options Prepare for changes in 2008 Make confident and informed decisions

Prescription Drug Coverage and Extra Help

7 Prescription Drug Coverage Coverage began January 1, 2006 Available for all people with Medicare Provided through Medicare Prescription Drug Plans Medicare Advantage Plans and other Medicare plans

8 Prescription Drug Costs Costs vary by plan Most people will pay Monthly premium Deductible Copayments or coinsurance Very little after $3,850 out-of-pocket in 2007 $4,050 out-of-pocket in 2008 Extra help for people with limited income and resources

9 Extra Help Eligibility determined by SSA or state Some groups are automatically eligible People with Medicare and Medicaid Supplemental Security Income only Medicare Savings Programs Everyone else must apply

10 How to Apply for Extra Help Multiple ways to apply Social Security Paper application (TTY ) State Medical Assistance office Local organization You or someone on your behalf can apply

11 Costs for Those With Extra Help Below Federal poverty level save over 95% People with lowest income and resources Pay no premiums or deductibles Have small or no copayments People with slightly higher income and resources Have a reduced deductible Pay a little more out of pocket

12 Continuing Eligibility for LIS CMS re-establishes eligibility each fall Extra help continued or changed Based on continued eligibility Changes effective January 1 Those automatically eligible for 2007 Continue to qualify through December 2007 People no longer eligible Automatic status will end December 31, 2007

Those With LIS Changes

14 Those with LIS Changes Loss of deemed status Change in extra help copayment Selected for review by SSA

15 Deemed Status Changes Two groups 1.Those who no longer qualify automatically 2.Those who qualify for 2008 but with a change of copayment level

16 1. No Longer Qualify for LIS CMS letter in September GREY PAPER No longer automatically qualify for LIS As of January 1, 2008 Application for extra help Action Apply for extra help Social Security Administration Or State Medical Assistance (Medicaid) office

17 2. Change in Copayment CMS letter in early October ORANGE PAPER Continue to qualify for extra help in 2008 Copayment levels change January 1, 2008 Action Keep the notice No action if information is correct

18 Selected for Review by SSA Social Security letter in September Form 1026 “Income and Resources Summary” sheet Action Return enclosed form within 30 days or extra help may terminate

19 Reassigning to New PDP Each fall, CMS reassigns LIS beneficiaries with 100% premium subsidy to a new PDP PDP is terminating Or PDP premium increase $1 over regional LIS premium subsidy amount Converting to enhanced benefit

20 Plan Terminating CMS letter in late October BLUE PAPER version 1 Current plan is leaving Medicare Program Reassigned to new plan effective January 1, 2008 Unless they join a new plan by December 31, 2007 Action Keep the notice Compare new 2008 plan with others Can choose to change plans

21 Premium Increase CMS letter in late October BLUE PAPER version 2 Current plan’s premiums increasing by more than $1 over LIS benchmark, or converting to enhanced Reassigned to new plan effective January 1, 2008 Unless they join a new plan by December 31, 2007 Action Keep the notice Compare new 2008 plan with others Can choose to change plans

22 How CMS Reassigns Attempt to find another plan Same organization No premium liability Promotes continuity Reassigned randomly if none available With plan below LIS

23 “Choosers” LIS with 100% premium subsidy Chose plan in 2006 or 2007 And Have premium increase over $1 CMS will conduct outreach Will not reassign

24 “Choosers” CMS LIS letter in October Premium is rising by more than $1 in 2008 Responsible for paying a portion unless they join a new plan Action May want to look for a new plan Compare current plan with others Can choose to change plans Early December is best time

25 Potentially Eligible Social Security letter in late November To people in Medicare Savings Programs Extra help available for drug plan costs Action Apply if you think you qualify for extra help Get more information from Social Security (TTY )

Resources to Help You

27 LIS Toolkit CMS Outreach Strategy Best practices from around the nation Maps to find those who need help Photo novellas Practical tools for counselors Other helpful resources

28 Enrollment Toolkit How to help Basic Part D education How current coverage works with Part D Choosing and joining a plan Extra help Additional resources

29 Enrollment Resources Personalized web tools On Medicare Prescription Drug Plan Finder Medicare Options Compare Partner support On Mailings to people with Medicare Publications for partners Toolkits

30 Training Resources Training on personalized web tools Designed for different purposes/audiences Drug Plan Finder Webinar Videos Online Includes links to materials mentioned here

31 Important Dates September 10-25SSA mails redetermination letters to certain LIS applicants September 17-20GREY LETTER mailed to those losing deemed status October 1Plans begin marketing October 2Terminating plans notify members

32 Important Dates Mid OctoberDrug Plan Finder with 2008 plan data available Mid OctoberORANGE LETTER to those deemed for LIS for next year, but copayment will change By October 31Annual Notice of Change sent By October 31Medicare & You handbook mailed

33 Important Dates Late OctoberBLUE REASSIGNMENT LETTERS mailed Late OctoberChoosers letter mailed November 15Enrollment for 2008 begins December 31Enrollment period ends

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