helping people eligible for extra help what you need to know about lis national medicare training...
TRANSCRIPT
Helping People Eligible for Extra HelpWhat You Need to Know about LIS
National Medicare Training Program
Audio-conference Training
September 26, 2007
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Today’s Topics
CMS strategies and objectives for 2008Overview of prescription drug coveragePeople with changes in 2008
AudiencesTarget messagesActions
Resources
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CMS Strategies
Annual enrollment period begins November 15 Year-round efforts to reach people with low-income Some will have changes for 2008
LIS eligibilityPlan enrollment
CMS specific focusThose potentially eligible for LISThose with LIS who face changes in 2008 premiums
July 2007 document describes our plans
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Looking at 2008
Review and select plans during the annual enrollment period
Greater number facing changes in 2008Some face increase in premium if they
remain in current plan1.5 million will be reassigned to a new plan
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CMS Objectives
Work with partners to help peopleUnderstand coverage and optionsPrepare for changes in 2008Make confident and informed decisions
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Prescription Drug Coverage
Coverage began January 1, 2006Available for all people with Medicare Provided through
Medicare Prescription Drug PlansMedicare Advantage Plans and other
Medicare plans
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Prescription Drug Costs
Costs vary by plan Most people will pay
Monthly premiumDeductibleCopayments or coinsuranceVery little after
• $3,850 out-of-pocket in 2007• $4,050 out-of-pocket in 2008
Extra help for people with limited income and resources
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Extra Help
Eligibility determined by SSA or stateSome groups are automatically eligible
People with Medicare and• Medicaid• Supplemental Security Income only• Medicare Savings Programs
Everyone else must apply
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How to Apply for Extra Help
Multiple ways to applySocial Security
• Paper application• www.socialsecurity.gov• 1-800-772-1213 (TTY 1-800-325-0778)
State Medical Assistance officeLocal organization
You or someone on your behalf can apply
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Costs for Those With Extra Help
Below Federal poverty level save over 95%People with lowest income and resources
Pay no premiums or deductiblesHave small or no copayments
People with slightly higher income and resourcesHave a reduced deductiblePay a little more out of pocket
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Continuing Eligibility for LIS
CMS re-establishes eligibility each fallExtra help continued or changed
Based on continued eligibility
Changes effective January 1Those automatically eligible for 2007
Continue to qualify through December 2007
People no longer eligibleAutomatic status will end December 31, 2007
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Those with LIS Changes
Loss of deemed statusChange in extra help copaymentSelected for review by SSA
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Deemed Status Changes
Two groups1. Those who no longer qualify automatically
2. Those who qualify for 2008 but with a change of copayment level
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1. No Longer Qualify for LIS
CMS letter in September GREY PAPERNo longer automatically qualify for LIS
• As of January 1, 2008
Application for extra help
ActionApply for extra help
• Social Security AdministrationOr
• State Medical Assistance (Medicaid) office
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2. Change in Copayment
CMS letter in early October ORANGE PAPERContinue to qualify for extra help in 2008Copayment levels change January 1, 2008
ActionKeep the noticeNo action if information is correct
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Selected for Review by SSA
Social Security letter in SeptemberForm 1026“Income and Resources Summary” sheet
ActionReturn enclosed form within 30 days or extra
help may terminate
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Reassigning to New PDP
Each fall, CMS reassigns LIS beneficiaries with 100% premium subsidy to a new PDP
• PDP is terminatingOr
• PDP premium increase • $1 over regional LIS premium subsidy amount• Converting to enhanced benefit
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Plan Terminating CMS letter in late October BLUE PAPER version 1
Current plan is leaving Medicare ProgramReassigned to new plan effective January 1, 2008
• Unless they join a new plan by December 31, 2007
ActionKeep the noticeCompare new 2008 plan with othersCan choose to change plans
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Premium Increase
CMS letter in late October BLUE PAPER version 2
Current plan’s premiums increasing by more than $1 over LIS benchmark, or converting to enhanced
Reassigned to new plan effective January 1, 2008• Unless they join a new plan by December 31, 2007
ActionKeep the noticeCompare new 2008 plan with othersCan choose to change plans
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How CMS Reassigns
Attempt to find another planSame organizationNo premium liabilityPromotes continuity
Reassigned randomly if none availableWith plan below LIS
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“Choosers”
LIS with 100% premium subsidyChose plan in 2006 or 2007
And
Have premium increase over $1
CMS will conduct outreach Will not reassign
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“Choosers”
CMS LIS letter in OctoberPremium is rising by more than $1 in 2008Responsible for paying a portion unless they
join a new planAction
May want to look for a new planCompare current plan with othersCan choose to change plans
• Early December is best time
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Potentially Eligible
Social Security letter in late NovemberTo people in Medicare Savings ProgramsExtra help available for drug plan costsAction
• Apply if you think you qualify for extra help• Get more information from Social Security
1-800-772-1213 (TTY 1-800-325-0778)
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LIS Toolkit
CMS Outreach StrategyBest practices from around the nation Maps to find those who need helpPhoto novellasPractical tools for counselorsOther helpful resources
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Enrollment Toolkit
How to help Basic Part D education How current coverage works with Part D Choosing and joining a plan Extra help Additional resources
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Enrollment Resources
Personalized web toolsOn www.medicare.gov
• Medicare Prescription Drug Plan Finder• Medicare Options Compare
Partner support• On www.cms.hhs.gov/Partnerships• Mailings to people with Medicare• Publications for partners• Toolkits
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Training Resources
Training on personalized web toolsDesigned for different purposes/audiences
Drug Plan Finder WebinarVideosOnline
www.cms.hhs.gov/NationalMedicareTrainingProgramIncludes links to materials mentioned here
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Important Dates
September 10-25 SSA mails redetermination letters to certain LIS applicants
September 17-20 GREY LETTER mailed to those losing deemed status
October 1 Plans begin marketing
October 2 Terminating plans notify members
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Important Dates
Mid October Drug Plan Finder with 2008 plan data available
Mid October ORANGE LETTER to those deemed for LIS for next year, but copayment will change
By October 31 Annual Notice of Change sent
By October 31 Medicare & You handbook mailed
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Important Dates
Late October BLUE REASSIGNMENT LETTERS mailed
Late October Choosers letter mailed
November 15 Enrollment for 2008 begins
December 31 Enrollment period ends
This training module provided by the
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