Information Memorandum Transmittal Aging and People with Disabilities
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1 Information Memorandum Transmittal Aging and People with Disabilities Kevin Nygren Number: APD-IM Authorized signature Issue date: 11/3/2017 Topic: Other Due date: Subject: MMA Transmittal: 2018 Medicare Part D Updates and Reassignments Applies to (check all that apply): All DHS employees Area Agencies on Aging: Type B Aging and People with Disabilities Self Sufficiency Programs County DD program managers ODDS Children s Residential Services Child Welfare Programs County Mental Health Directors Health Services Office of Developmental Disabilities Services (ODDS) ODDS Children s Intensive In Home Services Stabilization and Crisis Unit (SACU) Other (please specify): Message: The Centers for Medicare and Medicaid Services (CMS) has announced the 2018 Stand-Alone Medicare Prescription Drug Plans (PDPs). The 2018 Benchmark premium amount for Oregon and Washington PDP Region is $ Clients eligible to receive full Low-income Subsidy (LIS) are any clients receiving Medicaid and/or a Medicare Savings program benefit (OSIPM, OPP, QMB, SMB, and SMF). 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 re-assigned. AARP Medicare Rx Walgreens (PDP) (S ) Members will be assigned to AARP Medicare Rx Walgreens (PDP) S WellCare Extra (PDP) (S ) Members will be assigned to WellCare Classic (PDP) S MSC 0080 (rev. 10/12/17)
2 sdf The 1 st attached document lists of all the PDP s that will be available in Oregon The Benchmark plans are highlighted. These plans will not charge full, LIS eligible clients a monthly premium. The 2 nd attached document is the 2018 LIS Reference Sheet This document provides the LIS levels and corresponding case coding for all categories of LIS eligibility for the 2018 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@dhsoha.state.or.us MSC 0080 (rev. 10/12/17)
3 2018 Medicare Part D Stand-Alone Prescription Drug Plans Includes all contracts/plans regardless of 2017 approval status/subject to change. Any plan that is not highlighted will have a monthly premium for all people. Oregon s Benchmark amount $34.58 Company Name Plan Name Benefit Type Monthly Drug Premium Contract ID Plan ID Aetna Medicare Aetna Medicare Rx Saver (PDP) Basic $32.60 S Asuris Northwest Health Asuris Medicare Script Basic (PDP) Basic $ S Asuris Northwest Health Cigna-HealthSpring Rx Cigna-HealthSpring Rx Asuris Medicare Script Enhanced (PDP) Enhanced $ S Cigna-HealthSpring Rx Secure (PDP) Basic $28.70 S Cigna-HealthSpring Rx Secure- Extra (PDP) Enhanced $49.40 S EnvisionRx Plus EnvisionRxPlus (PDP) Basic $12.60 S Express Scripts Medicare Express Scripts Medicare Express Scripts Medicare - Value (PDP) Basic $49.60 S Express Scripts Medicare - Choice (PDP) Enhanced $88.60 S Express Scripts Medicare First Health Part D Express Scripts Medicare - Saver (PDP) Enhanced $22.60 S First Health Part D Value Plus (PDP) Enhanced $56.20 S
4 First Health Part D First Health Part D Premier Plus (PDP) Enhanced $93.80 S Humana Insurance Company Humana Enhanced (PDP) Enhanced $73.80 S Humana Insurance Company Humana Preferred Rx Plan (PDP) Basic $32.50 S Humana Insurance Company Humana Walmart Rx Plan (PDP) Enhanced $20.40 S SilverScript SilverScript Choice (PDP) Basic $30.40 S SilverScript SilverScript Plus (PDP) Enhanced $69.10 S UnitedHealthcare Symphonix Value Rx (PDP) Basic $28.10 S UnitedHealthcare AARP MedicareRx Preferred (PDP) Enhanced $86.20 S UnitedHealthcare AARP MedicareRx Saver Plus (PDP) Basic $44.80 S UnitedHealthcare AARP MedicareRx Walgreens (PDP) Enhanced $26.70 S WellCare WellCare Classic (PDP) Basic $30.30 S WellCare WellCare Value Script (PDP) Enhanced $37.20 S *Benchmark-A prescription drug plan with a monthly premium at or below the low income premium subsidy amount
5 2018 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 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 $3.35 and $8.35 in 2018 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 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 $1.25 and $3.70 in 2018 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 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. These clients should have an OSP medical Program Coding on the UCMS
6 screen, with case descriptors of APD/IHC, APD/CBF, DDC, DDS, DDK, and 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 2018 are limited to: $83.00 annual deductible 15% of the prescription costs up to $ 5,000 out-of pocket Co-payments limited to $3.35 for each generic drug and $8.35 for each name brand drug after the annual prescription costs exceed $5,000 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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