Mental Health Part D News Alert

October 2, 2006

Premium Change for Low Income Subsidy (LIS) Beneficiaries

Note: if your plan premium is not above the limit, you will not be reassigned and therefore will receive no letter. [Reassignment in this case is limited to a specific subset of the LIS population.]

Note: Beneficiaries in Plans continuing in Plan Year 2007 must receive appropriate Annual Notice of Coverage (ANOC) by October 31st.

1) CMS will send notices mid-November to all reassigned Low Income Subsidy (LIS) beneficiaries with the name of their “preliminary” new Plan for 2007. The notice of reassignment will also include instructions on what to do if the beneficiary wishes to continue with their old Plan in 2007 at the new premium rate.

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.

Note: reassignment/auto-enrollment is not tailored to individual beneficiary requirements (e.g., the specific medication requirements will not have been reviewed). We recommend that patients review all materials, including Annual Notice of Coverage (ANOC) sent by the Plan(s), especially for the Plan formulary and the Utilization Management (UM) requirements (Prior Authorization, Step Therapy, Quantity Limits, etc) for their medications to determine coverage. We recommend that patients also contact the Plan directly for details on specific requirements for Prior Authorization, Step Therapy, Quantity Limits, and coverage for their medications. If the Plan is a good fit, there is no need to change. If the Plan is not a good fit, then a new Plan should be chosen using the tools on www.medicare.gov. Before making a final decision always call the Plans to confirm information on this site.

2) LIS beneficiaries who switched out of their auto-assigned Plan and enrolled in their current Plan in 2006 must review their Plan’s ANOC for changes to the 2007 premium. CMS will not send a notice of premium change to this group of beneficiaries. They may either choose to stay in their current Plan and pay the new required premium (incur premium liability), or they may choose to enroll in a different Plan.

For a general comparison of Plans, go to the Plan Comparison feature on the Medicare Prescription Drug Plan Finder (www.medicare.gov) and follow the steps. The tool provides general information on monthly premiums, monthly cost for medications and general UM measures. Before making a final decision always call the Plans to confirm information on this site.

Note: Enrollees who lose their LIS eligibility for 2007, as well as LIS-eligible enrollees in MA Plans, Cost Plans, Employer-Sponsored Plans, PACE organizations, or PDPs in U.S. territories will not be reassigned regardless of change in premium amount; they will be informed of other plan options in the ANOC from their current Plan. They may choose to stay in their Plan if it is a good fit, or to change Plans.

Note: In Aug/Sept CMS and SSA (Social Security Administration) mailed notices to the address of record to all who applied for and received the LIS benefit in 2006 to determine whether they will qualify in 2007.

Automatic LIS eligibility will end on December 31, 2006 for people who are no longer a full-benefit dual-eligible, partial dual-eligible (Medicare Savings Program participant), or Supplemental Security Income (SSI) recipient. CMS mailed letters PDF explaining the pending loss of LIS eligibility and included an SSA application to complete and return.

CMS also sent a letter PDF to beneficiaries who continue to qualify for the LIS in 2007 but will have a change in co-pay level from 2006 to 2007. Deemed beneficiaries whose LIS status for 2007 is unchanged were not sent letters.

Note: Since all letters are sent to the address of record (beneficiary or representative payee) on file with the Social Security Administration, if beneficiary/representative payee has moved and not updated contact information they may not receive notices. Please be certain that contact information is correct.