Mental Health Part D News Alert

October 2, 2006

Plan Termination

Plans must send all their enrollees a notice if the Plan is terminating. Enrollees must receive this termination notice by October 1st.

Low Income Subsidy (LIS) enrollees: CMS will send notices of Plan reassignment (effective 1/1/07) in early November to all LIS patients with Plans terminating December 31st who either 1) had remained in their auto-assigned 2006 plan or 2) had voluntarily elected a plan in 2006. CMS will automatically reassign these beneficiaries to another Plan.

Note: if your Plan is not terminating, you will not be reassigned and therefore will receive no termination notice.

There are 2 possibilities for this reassignment:

1. CMS will reassign beneficiaries to another Plan from the same PDP. The new Plan will have basic prescription drug coverage and a premium at or below the low-income benchmark amount. If the PDP has more than one plan, CMS will randomly assign beneficiaries among these Plans.
2. If no such Plan exists, CMS will reassign beneficiaries randomly among PDPs to Plans with basic prescription drug coverage and a premium at or below the low-income benchmark amount.

Non LIS enrollees whose Plan will terminate in 2007 must choose a new Plan or may have to pay a penalty to join after the Open Enrollment period if they don’t have other credible drug coverage. As of January 1, 2007 medications will no longer be available through the terminated 2006 Plan.

Note: reassignment/auto-enrollment is not tailored to individual beneficiary requirements (e.g., the specific medication requirements will not have been reviewed) and therefore it is important for the patient to review the Plan’s formulary for inclusion of appropriate medications, Utilization Management requirements, etc.

If the Plan assignment is not a good fit, the patient can choose a different plan. CMS has improved the tools to assist beneficiaries to review Plan choices (www.medicare.gov). Before making a final decision always call the Plans to confirm information on this site.