2006 National Medicare Training Centers for Medicare & Medicaid Services

1. Update on Prescription Drug Coverage • 2006 National MedicareTraining • Centers for Medicare & Medicaid Services • Presenters: Kay Pokrzywa • Jeff Maready

2. Medicare Prescription Drug Coverage Enrollment after May 15

3. New to Medicare • People newly entitled to Medicare • 7-month initial enrollment period for Part D • 3 months before month of eligibility • Coverage begins on date eligible • Month of eligibility • Coverage begins first of the following month • 3 months after month of eligibility • Coverage begins first of the following month

4. New to Medicare • Full Medicaid and new to Medicare • Auto-enrolled in a plan for coverage first day of Medicare entitlement unless • Chooses own plan during first 3 months of IEP, or • Calls 1-800-Medicare or plan and opts out of enrollment • Can change plans at any time

5. New to Medicare • New to Medicare and SSI, MSP*, or found eligible for extra help • Facilitated into a plan for coverage unless • Chooses own plan during first 3 months of IEP • Enrolled in employer plan receiving subsidy • Calls 1-800-Medicare or plan and opts out of enrollment • People with MSP can change plans at any time • Others facilitated into a plan by CMS • Get one SEP before end of year • Can switch plans or disenroll *Medicare Savings Program: QMB, SLMB, QI

6. New to Extra Help • Already has Medicare and found eligible for extra help after May 15 • Plan will refund costs back to effective date • Found eligible through state data • Medicaid (full dual-eligibles) • If not in a Part D plan, auto-enrolled • Once CMS notified by state, retroactive to the month of Medicaid eligibility • Can choose own plan prior to auto-enrollment • Can switch plans at any time

7. New to Extra Help(continued) • Found eligible through state data • Medicare Savings Programs • Not in Part D plan, facilitated into a plan • Can choose own plan prior to facilitated enrollment • Can switch plans at any time

8. New to Extra Help(continued) • Found eligible through entitlement to SSI-only or by applying for extra help • Currently in Part D plan • Plan notified of LIS eligibility • Not currently in Part D plan • Can choose own plan prior to facilitated enrollment • SEP to switch plans once before end of year • Can switch plans or disenroll

9. Auto and Facilitated Enrollment • Plans are randomly assigned • Premiums at/below regional benchmark • People already in MA plan • Enrolled in MA-PD, if offered by the MA organization

10. Enrollment Notices • CMS will notify people who will be enrolled in a PDP • Auto-enrolled receive letter on yellow paper • Facilitated receive letter on green paper • Two versions • Full subsidy • Partial subsidy • Include list of plans • In that region • At/below benchmark premium • MA plan sends notice if enrolling member in MAPD

11. Beneficiary Options • Enroll in plan of their choice • Allow auto or facilitated enrollment to take effect • At least one opportunity to change or drop coverage • Decline to be enrolled in a plan • Call 1-800-Medicare or • Call the plan named in the notice, and • Ask to disenroll from plan AND not be enrolled again by Medicare

12. Enrolling for Plan Year 2007 • Annual Coordinated Election Period (AEP) • November 15 – December 31, 2006 • All people with Medicare • Can join, drop, or switch coverage • Effective January 1, 2007 • AEP each year • MA Open Enrollment Period • January 1 – March 31, 2007

13. Open Enrollment Limit During the MA Open Enrollment Period Ref: Medicare & You 2006, pg. 65

14. Annual Coordinated Election Period (AEP) • People can join, drop, or switch • Prescription drug plans • Medicare Advantage plans • Medicare Advantage plans with prescription drug coverage

15. Extra Help Redeterminations • LIS eligibility redetermined by SSA • Based on information available to SSA • LIS eligibility redetermined by the state • Same manner and frequency as redeterminations made under the state’s plan • Generally, no need to reapply for LIS • May need to apply for LIS if beneficiary loses deemed status

16. Resources • Guide to Medicare's Preventive Services • Publication 10110 • CMS prevention website • Go to cms.hhs.gov • Click on Medicare • Scroll down and click on Prevention • E-mail prevention questions and suggestions • prevention@cms.hhs.gov • PDP Guidance • Eligibility, Enrollment, and Disenrollment • Tip sheet for partners • Reimbursement Guidance 4-18-06.qxp

17. For More Information • Visit www.cms.hhs.gov • Call 1-800-MEDICARE • Call State Health Insurance Assistance Program (SHIP) • Call 1-800-MEDICARE (1-800-633-4227) for SHIP telephone number • TTY users should call 1-877-486-2048