BBI: Reminder: Medicare Open Enrollment Date

Open enrollment for some people ends this weekend, so keep the following in mind. [Thanks to A-List Promo for the image.]

From NAMI:

Who Needs to Contact Medicare Before Midnight December 31?

The short answer is anyone who wants to switch their drug coverage for the coming year, or who did not enroll in 2006. In addition, Medicare beneficiaries who are happy with their prescription coverage also need to carefully check into changes in coverage for 2007 including:

Changes in premiums and cost sharing,
Adjustments to formularies (the list of covered drugs),
Movement of specific drugs to different cost sharing tiers, or
Imposition of new or different utilization management policies on specific medications (prior authorization, step therapy, quantity limits, etc.).

If a Medicare drug plan made any of these adjustments to their coverage policies for 2007, then they were required to notify all enrollees in writing by October 31 through an “Annual Notice of Change” or ANOC letter. In addition, Medicare has also been sending notices of changes in coverage in recent, especially for dual eligibles whose status as “Low Income Subsidy” is changing (see details below).

“Re-Deeming” of Certain Dual Eligibles

Of particular concern to NAMI in the transition to the new plan year on January 1 are low-income Medicare beneficiaries who had dual eligible or “Low Income Subsidy” (LIS) status in 2006, who will not in 2007. These are individuals that prior to 2006 qualified for Medicaid in their state as a result high medical expenses and “spend-down” eligibility. Most of these dual eligibles were automatically enrolled in a Part D plan for 2006.

For 2007 however, many will not have dual eligible status because they never reached the Medicaid “spend-down” level in 2006. Others have experienced some other “change in status” that has prevented CMS from “deeming” them (making them automatically) eligible for LIS or dual status in 2007.

These individuals will need to send in a new application for the Medicare Part D “Low Income Subsidy” (LIS) in order to access affordable drug coverage for 2007 (in most cases, coverage with no monthly premium, no deductible, no gap in coverage and as little as $3 for a generic, and $5 for a brand name prescription). A number of Part D drug plan sponsors have already announced their intentions to provide a 90-day grace period in which higher cost sharing and deductibles will NOT be assessed against anyone losing “deemed” dual eligible or LIS status. Further, CMS is providing a special 90-day open enrollment period (through March 31, 2007) under which low-income beneficiaries losing automatic dual eligible for LIS can select a different drug plan if they wish.

Notices from CMS to these “deemed” individuals were sent in September (a letter printed on blue paper), with an LIS application and postage paid envelope. For more information on this important issue, click here and here.

More Web-Based Tools Available

In addition to the resources listed above, more web-based information about the Medicare prescription drug benefit is available through the following links. The new “My Health/My Medicare” Campaign designed to promote on-line personalized information.

Mental Health Part D

Map of Rx

liz | 10:46 AM | Uncategorized