Information Memorandum Transmittal

Transcription

1 Seniors and People with Disabilities Information Memorandum Transmittal Patricia Baxter Number: SPD-IM Authorized Signature Issue Date: 12/8/2011 Topic: Other Subject: MMA Transmittal: 2012 Medicare Part D Reassignment Applies to (check all that apply): All DHS employees Area Agencies on Aging Children, Adults and Families County DD Program Managers County Mental Health Directors Health Services Seniors and People with Disabilities Other (please specify):. Message: The Centers for Medicare and Medicaid Services (CMS) has announced the 2012 Stand-Alone Medicare Prescription Drug Plans (PDPs). The 2012 Benchmark premium for Oregon and Washington PDP Region is $ The Benchmark amount has gone up. Clients eligible to receive the full Low-Income Subsidy (LIS) are any clients receiving Medicaid and/or a Medicare Saving program benefit (OSIPM/OHP, MAA, OPP, QMB, SMB, and SMF). The following 2011 $0 premium plan will no longer be a $0 premium plan for Plan Name, Contract & ID # AARP Medicare Rx Preferred (S ) 2012 Premium for Duals $5.45 per month DHS 0080 (01/09)

2 Clients who are currently in the above plan and were enrolled via an auto-enrollment or facilitated enrollment will be reassigned to another premium free PDP. Clients who chose any of the above plans will not be reassigned to another plan. If the client does not make a change to full LIS, the client will be charged the monthly premium for 2012 coverage. The following plans will no longer be Medicare Stand-Alone prescription plans for Clients in these plans will be reassigned to collating plans or randomly reassigned. Medco Medicare Prescription Plan-Choice Enhanced (S ) Aetna Medicare Rx Cosco Plus Plan (S ) EnvisionRxPluse Gold Enhanced (S ) Advange Star Plan Basic (S ) CIGNA Medicare Rx Enhanced (S ) ****Sterling Rx (S ) plan name has been changed to Winsor Rx. The company name remains the same Sterling Life Insurance. The 1 st attached document lists all of the PDPs that will be available in Oregon for The benchmark plans are highlighted. These plans will not charge full, LIS eligible clients a monthly premium. There are more bench mark plans in 2012, giving clients more plan options to choose from. The 2 nd attached document is the 2012 LIS Reference Sheet. This document provides the LIS levels and corresponding case coding for all categories of LIS eligibility for the 2012 calendar year, including individuals that apply through the Social Security Administration If you have any questions about this information, contact: Contact(s): Kesha Baxter Phone: Fax: Kesha.L.Baxter@state.or.us DHS 0080 (01/09)

3 2012 LIS Reference Sheet LIS Category 1 Who: Individuals with Medicare and Medicaid whose income is above 100% of Federal Poverty Level. The UCMS screen for the client s Program Codes of OSP and FS2 case descriptor; or, Individuals who are enrolled in a Medicare Savings Program. These clients may have a MED, SMB or SMF in the UCMS screen for the Medical Program, with any of the following case descriptors: FS2, FS1, SMB, SMF, or QMB. These clients do not have OSP or MAA program code; or, Individuals with Medicare whose income is below 135% of Federal Poverty Level, with limited resources who have been approved by SSA. Benefit: No monthly premium for benchmark plans and no deductible Copayments limited to $2.60 and $6.50 in 2012 LIS Category 2 Who: Individuals with both Medicare and Full Medicaid coverage (Full-Benefit Dual Eligibles) whose income is below 100% of FPL, who do not reside in an institution. These clients should have OSP or MAA medical Program Coding on the UCMS screen, with QMB or QMM and FS1 case descriptors. All SSI clients are eligible for LIS category 2 even without the QMB coding (Exp: clients with no Medicare part A). Benefit: No monthly premium for benchmark plans and no deductible Copayments limited to $1.10 and $3.30 in 2012 LIS Category 3 Who: Individuals with both Medicare and full Medicaid coverage (Full Benefit Dual-Eligibles) who are expected to be institutionalized in a Nursing facility or other medical facility for a full calendar month these clients should have an OSP or MAA medical Program Coding on the UCMS screen, with a case descriptor of ISI. -Or Individuals with both Medicare and full Medicaid (Full Benefit Dual-Eligibles) who receives Home and Community-Based Services, in a waivered facility.

4 These clients should have an OSP or MAA medical Program Coding on the UCMS screen, with case descriptors of CBF, IHC, DDC, DDS, ICP. Benefit: No monthly premium for benchmark plans, no deductible, and no copayments on Medicare Part D covered drugs. LIS Category 4 Who: People with Medicare (no Medicaid or MSP) whose income is between 135% of FPL and 150% of FPL and who have limited resources. These individuals must apply for the LIS with SSA. Benefit: A subsidy covering up to 75% of the monthly benchmark premium and: Out of pocket expenses in 2012 are limited to: $65.00 annual deductible 15% of the prescription costs up to $ 4,700 out-of pocket Co-payments limited to $2.60 for each generic drug and $6.50 for each name brand drug after the annual prescription costs exceed $4,700 out-ofpocket spending Any Partial or Full dual eligible who has been deemed by the Department with any of the above eligibility from July through December of a given year, will retain their copayment levels for the following calendar year. SSA will review eligibility at the end of each calendar year for those that apply through their system. If an individual loses his or her eligibility during the calendar year, he or she will not lose the benefit until the end of the calendar year.

5 2012 Medicare Part D Stand-Alone Prescription Drug Plans Includes all contracts/plans regardless of 2012 approval status/subject to change. Any plan that is not highlighted will have a monthly premium for all people. Oregon s Benchmark $36.45 State Name Plan Name Monthly Drug Contract ID Plan ID Premium Oregon Aetna Medicare Aetna Medicare Rx Essentials (PDP) $52.10 S Oregon Aetna Medicare Aetna Medicare Rx Premier (PDP) $87.10 S Oregon Asuris Northwest Asuris Medicare Script Basic (PDP) $74.50 S Health Oregon Asuris Northwest Asuris Medicare Script Enhanced (PDP) $ S Health Oregon CIGNA Medicare Rx CIGNA Medicare Rx Plan One (PDP) $49.00 S Oregon Community CCRx PDP Community CCRx Basic (PDP) $33.40 S Oregon Community CCRx PDP Community CCRx Choice (PDP) $83.70 S Oregon EnvisionRx Plus EnvisionRxPlus Silver (PDP) $32.70 S Oregon EnvisionRx Plus Rite Aid EnvisionRxPlus (PDP) $66.70 S Oregon First Health Part D First Health Part D Premier Plus (PDP) $ S Oregon First Health Part D First Health Part D Premier (PDP) $31.20 S Oregon First Health Part D First Health Part D Value Plus (PDP) $25.20 S Oregon Health Net Health Net Orange Option 1 (PDP) $35.80 S Oregon Health Net Health Net Orange Option 2 (PDP) $82.30 S

6 Oregon HealthSpring Prescription Drug Plan HealthSpring Prescription Drug Plan-Reg 30 (PDP) $35.90 S Oregon Humana Insurance Humana Enhanced (PDP) $35.10 S Oregon Humana Insurance Humana Complete (PDP) $ S Oregon Humana Insurance Humana Walmart-Preferred Rx Plan (PDP) $15.10 S Oregon Medco Medicare Medco Medicare Prescription Plan - Value $43.10 S Prescription Plan (PDP) Oregon SilverScript Insurance CVS Caremark Value (PDP) $32.30 S Oregon SilverScript Insurance CVS Caremark Plus (PDP) $78.30 S Oregon Sterling Life Insurance Windsor Rx (PDP) $31.10 S Oregon UniCare MedicareRx Rewards Standard (PDP) $48.60 S Oregon UniCare MedicareRx Rewards Plus (PDP) $92.90 S Oregon United American United American - Preferred (PDP) $51.30 S Insurance Oregon United American United American - Select (PDP) $42.20 S Insurance Oregon UnitedHealthcare AARP MedicareRx Preferred (PDP) $41.90 S Oregon UnitedHealthcare AARP MedicareRx Enhanced (PDP) $91.90 S Oregon WellCare WellCare Signature (PDP) $70.90 S Oregon WellCare WellCare Classic (PDP) $36.00 S *Benchmark-A prescription drug plan with a monthly premium at or below the low income premium subsidy amount.