Information Memorandum Transmittal
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1 Seniors and People with Disabilities Information Memorandum Transmittal DeAnna Hartwig Number: SPD-IM Authorized Signature Issue Date: 11/17/2009 CORRECTED Topic: Other Subject: MMA Transmittal: 2010 Medicare Part D Plan 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 2010 Stand-Alone Medicare Prescription Drug Plans (PDPs). The 2010 Benchmark premium for and Washington PDP Region is $ 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). Currently there are seven Medicare Part D Stand-Alone plans under s bench mark; however in 2010 there will be nine. The following two plans have been added to the Benchmark listing. Health Net Orange Option 1 (S ) Aetna Medicare Rx Essentials PDP (S ) Other changes to note: At this time WellCare Classic (S ) and WellCare Signature (S ) are not accepting any new enrollees for 2009 or They will continue to serve current enrollees enrolled in the plans. ***Also in 2010 WellCare Classic will no longer offer zero co-pays for generics. *********In 2010 Prescriba Rx Bronze (S ) company name will no longer be Pennsylvania Life. It has been changed to Universal American. DHS 0080 (01/09)
2 Reminder- There is no longer a De Minimis policy. Therefore, clients will be subject to pay any premium amount over the Benchmark. The attached listing of plans includes all plans eligible for purchase in in The highlighted plans are those that will have no premium for dual-eligible and Medicare Savings Program clients. The 2 nd attached document is the 2010 LIS Reference Sheet. This document provides the LIS levels and corresponding case coding for all categories of LIS eligibility for the 2010 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 2010 Medicare Part D Stand-Alone Prescription Drug Plans Includes all contracts/plans regardless of 2010 approval status-subject to change. Any plan that is not highlighted will have a monthly premium for all people s - Benchmark $35.60 State Company Name Plan Name Benefit Type Monthly Premium Contract Plain Aetna Medicare Aetna Medicare Rx Costco Plus Plan (PDP) Enhanced $36.50 S Aetna Medicare Aetna Medicare Rx Essentials (PDP) Basic $26.20 S Aetna Medicare Aetna Medicare Rx Premier (PDP) Enhanced $ S Asuris Northwest Health Asuris Medicare Script (PDP) Basic $74.50 S Asuris Northwest Health Asuris Medicare Script Enhanced (PDP) Enhanced $92.50 S CIGNA Medicare Rx CIGNA Medicare Rx Plan One (PDP) Basic $43.10 S CIGNA Medicare Rx CIGNA Medicare Rx Plan Three (PDP) Enhanced $69.80 S CIGNA Medicare Rx CIGNA Medicare Rx Plan Two (PDP) Basic $47.10 S Coventry AdvantraRx AdvantraRx Premier (PDP) Basic $47.20 S Coventry AdvantraRx AdvantraRx Premier Plus (PDP) Enhanced $67.10 S Coventry AdvantraRx AdvantraRx Value (PDP) Enhanced $29.90 S EnvisionRx Plus EnvisionRxPlus Gold (PDP) Enhanced $57.30 S EnvisionRx Plus EnvisionRxPlus Silver (PDP) Basic $43.10 S First Health Part D First Health Part D-Premier (PDP) Basic $33.40 S First Health Part D First Health Part D-Secure (PDP) Enhanced $8.80 S Health Net Health Net Orange Option 1 (PDP) Basic $33.60 S Health Net Health Net Orange Option 2 (PDP) Enhanced $67.40 S HealthSpring Prescription Drug Plan HealthSpring Prescription Drug Plan-Reg 30 (PDP) Basic $28.30 S Humana Insurance Company Humana Complete S (PDP) Enhanced $ S Humana Insurance Company Humana Enhanced S (PDP) Basic $40.10 S Humana Insurance Company Humana Value S (PDP) Enhanced $18.60 S Medco Medicare Prescription Plan Medco Medicare Prescription Plan - Access (PDP) Enhanced $85.40 S Medco Medicare Prescription Plan Medco Medicare Prescription Plan - Choice (PDP) Enhanced $54.40 S
4 State Company Name Plan Name Benefit Type Monthly Premium Contract Plain Medco Medicare Prescription Plan Medco Medicare Prescription Plan - Value (PDP) Basic $32.60 S RxAmerica Advantage Freedom Plan by RxAmerica (PDP) Enhanced $56.50 S RxAmerica Advantage Star Plan by RxAmerica (PDP) Basic $45.90 S SilverScript Insurance Company CVS Caremark Complete (PDP) Enhanced $78.30 S SilverScript Insurance Company CVS Caremark Plus (PDP) Enhanced $49.70 S SilverScript Insurance Company SilverScript Value (PDP) Basic $34.60 S Sterling Life Insurance Company Sterling Rx (PDP) Basic $47.20 S UniCare MedicareRx Rewards Plus (PDP) Enhanced $48.50 S UniCare MedicareRx Rewards Standard (PDP) Basic $40.20 S United American Insurance Company UA Medicare Part D Prescription Drug Cov (PDP) Enhanced $48.30 S United American Insurance Company UA Medicare Part D Rx Covg - Silver Plan (PDP) Basic $45.50 S UnitedHealthcare AARP MedicareRx Enhanced (PDP) Enhanced $83.90 S UnitedHealthcare AARP MedicareRx Preferred (PDP) Basic $40.80 S UnitedHealthcare AARP MedicareRx Saver (PDP) Basic $29.80 S Universal American Community CCRx Basic (PDP) Basic $32.80 S Universal American Community CCRx Choice (PDP) Enhanced $37.80 S Universal American Community CCRx Gold (PDP) Enhanced $56.60 S Universal American PrescribaRx Bronze (PDP) Basic $28.10 S Universal American PrescribaRx Gold (PDP) Enhanced $32.50 S WellCare WellCare Classic (PDP) Basic $39.20 S WellCare WellCare Signature (PDP) Enhanced $45.50 S * Bench Mark- A prescription drug plan with a monthly premium at or below the low income premium subsidy amount. 2
5 2010 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 $2.50 and $6.30 in 2010 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 2010 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. Benefit: No monthly premium for benchmark plans, no deductible, and no copayments on Medicare Part D covered drugs.
6 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 2010 are limited to: $63.00 annual deductible 15% of the prescription costs up to $ 4,550 out-of pocket Co-payments limited to $2.50 for each generic drug and $6.30 for each name brand drug after the annual prescription costs exceed $4,550 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.
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