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Medicare Details Actions to Assure Dual Eligibles
Enroll in Drug Program
Nov. 2, 2005 – Medicare today detailed the actions
being taken to assure that “dual eligibles” – those senior citizens who
qualify for both Medicare and Medicaid – are enrolled in the
prescription drug program (Medicare Part D) and receive the financial
assistance for which they qualify. The enrollment of these beneficiaries
has been a major concern of many advocacy groups.
Medicare’s prescription drug coverage is available
to everyone in Medicare, regardless of their income or how they get
their Medicare. For those with limited incomes, there is extra help that
will provide comprehensive coverage for no premium and no deductible.
Medicare beneficiaries who also get Medicaid, the
state-federal assistance program for those with low incomes,
automatically qualify for this extra help. These “full-benefit dual
eligibles” are being automatically and randomly enrolled in a
prescription drug plan to make sure that they do not lose a day of
prescription coverage.
This week, the Centers for Medicare & Medicaid
Services began mailing letters to these 5.5 million Medicare
beneficiaries. The letters let the beneficiary know which Medicare
prescription drug plan they will be enrolled in if they take no action
prior to January 1. A copy of the letter is attached and also available
online at
www.cms.hhs.gov/medicarereform/factsheets.asp
These letters are being mailed first class, so all
“undeliverables” will be returned to CMS. CMS will follow up on each
undeliverable notice in order to send to the correct address.
The letters are just one in a series of actions CMS
is taking to make sure people who get Medicare and Medicaid are aware of
the coming changes in their prescription drug coverage. Direct mail is
one component:
● In May, full-benefit dual eligibles received a
letter from CMS informing them that they automatically qualify for the
low-income subsidy and do not need to apply.
● In October, all Medicare beneficiaries received
the “Medicare & You” 2006 handbook.
● Also, Medicare prescription drug plans will mail
enrollment materials to the full-benefit dual eligible beneficiaries
assigned to their plan. Those materials include a list of covered drugs
and the pharmacy network.
Also, if a full-benefit dual eligible beneficiary
goes to a pharmacy after January 1 unaware that prescription drug
coverage is now through Medicare, the pharmacist can determine the
beneficiary’s enrollment information by submitting an on-line query
through its billing system. If the pharmacy is in network, the
pharmacist can then fill the prescription with no further information
required from the beneficiary for billing. If the pharmacy is not in
network, the pharmacist can help the beneficiary call their plan’s help
desk or 1-800-MEDICARE to determine a participating pharmacy.
Helping Dual Eligible Beneficiaries Make an
Informed Choice
All of the plans that qualify for the automatic
enrollment must meet Medicare’s standards for access to medically
necessary drugs at a convenient local pharmacy. Beneficiaries who
prefer a different plan can change at any time.
The letters will also help ensure that full-benefit
dual eligible beneficiaries are aware that they can choose a different
zero-premium plan in their area, and that they can call 1-800-MEDICARE
to find out more about these plans.
CMS is taking this and many other steps to make
sure beneficiaries are able to enroll in a zero-premium plan option if
that is what they prefer. While there are many sources of information
and help in choosing such a plan, the “Medicare & You” 2006 handbook
included a table on page 97A that erroneously said that all plans in
every area would charge no premium for those who qualify for the
low-income subsidy.
Before they choose another plan, beneficiaries have
many sources of accurate, personalized information on their coverage
options:
● Even before enrollment begins on November 15,
beneficiaries can get personalized information by calling
1-800-MEDICARE. They, a counselor or caregiver can also get the same
material at
www.medicare.gov.
● Medicare’s thousands of outreach and enrollment
partners nationwide have complete information on plans in their area.
They have received training on using this information to help
beneficiaries choose.
● Many states are also providing assistance, and
have access to the same personalized information to help beneficiaries
choose.
● Nursing facilities caring for Medicare
beneficiaries can also get information on whether the beneficiary is
eligible for extra help, and the plan to which the beneficiary has been
assigned, enabling them to help make sure prescription drug needs will
be met as effectively as possible.
When the beneficiary chooses a prescription drug
plan, there are several steps to make sure that the beneficiary knows if
they are joining a plan with a premium:
● If they call 1-800-MEDICARE or they or a
caregiver uses
www.medicare.gov, they will be informed if they have chosen a plan
with a non-zero premium and given assistance if they wish to choose a
plan with no premium.
● If they contact a health plan, the plan is
required to notify them that they would pay some premium for their
current choice of coverage and that zero-premium options are available –
either from that plan (if such an option is offered) or by contacting
Medicare.
For all of these reasons, and because all
zero-premium plans provide comprehensive coverage with convenient access
to all medically necessary treatments, Medicare expects very few dual
eligible beneficiaries will enroll in a drug plan with a premium unless
they wish to do so.
To make sure that any low-income beneficiary who
actually does enroll in a plan with a premium was fully informed and
intended to do so, Medicare will:
● Track beneficiary enrollments to identify
beneficiaries who enroll in a plan that has a premium even though they
are eligible for a zero-premium plan, and send a letter making sure they
know about the zero-premium options.
● Allow beneficiaries who mistakenly enroll in a
plan for which they will have a premium liability to change to a plan
where they would not have to pay any premium.
● Require Medicare prescription drug plans to
include information about plan premiums in their pre-enrollment
materials.
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