Information Memorandum Transmittal

Transcription

1 Seniors and People with Disabilities Information Memorandum Transmittal Jane-ellen Weidanz Number: SPD-IM Authorized Signature Issue Date: 11/02/2005 Topic: Medical Benefits Subject: MMA Transmittal: CMS Begins Mailing Autoenrollment Letters 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 Center for Medicaid and Medicare Services (CMS) has begun mailing notices to dual eligible clients (those with Medicare and Medicaid) about their autoenrollment into a PDP. This letter will be sent to more than 29,000 DHS clients and should be received by November 5, A sample of the letter, FAQ and a CMS fact sheet are attached. The letter provides the name of the plan and contact information for the plan that client has been enrolled in. The letter summarizes the client s specific copayment responsibility. The letter recommends that clients contact Medicare, SHIBA and the plan directly for assistance. The official letter is supposed to be on yellow paper. This notice from CMS may cause clients to call local offices. Local offices should: o Provide information about Medicare Prescription Drug program including copayment requirements; o Offer enrollment assistance to begin November 15, 2005; and o Clearly explain that clients who drop the Medicare Prescription Drug benefit will not receive prescription drug coverage from Medicaid. They will have to pay their entire prescription drug costs. If you have any questions about this information, contact: Contact(s): Max Brown, Christina Jaramillo & Jane-ellen Weidanz Phone: , , or Fax: christina.d.jaramillo@state.or.us max.brown@state.or.us janeellen.a.weidanz@state.or.us DHS 0080 (02/04)

2 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services <Beneficiary Full Name> <Address> <City, State Zip> 7500 Security Boulevard Baltimore, MD HICN <1234> <file creation date> Dear <Beneficiary Full Name>, Please read this letter carefully because your prescription drug coverage is changing. You are getting this letter because our records show that you have Medicare and that you were eligible for Medicaid in all or part of this year. Starting January 1, 2006, Medicare will help pay for your prescription drugs instead of Medicaid. If you continue to be eligible for Medicaid, Medicaid will still pay for your health care costs that Medicare doesn t cover. To get Medicare prescription drug coverage, you will need to choose and join a Medicare drug plan. Call MEDICARE ( ) for a list of the prescription drug plans with no premium in your area, other drug coverage options and help comparing plans and joining a plan that works for you. If you do not join a Medicare drug plan by December 31, 2005, Medicare will enroll you in <Organization name> s <Name of plan> and your coverage will begin January 1, With this Medicare-approved drug plan, you will pay $0 for your monthly prescription drug plan premium, $0 for your yearly prescription drug plan deductible, and <insert LIS copayment amount> copayment when you fill a prescription covered by the plan. Please read the attached questions and answers for more information about your new prescription drug coverage and what to do now. For more information about <Name of plan>, call <Plan phone> or visit <Plan website> on the web. If you need help understanding this letter, please show it to a family member, friend, case manager, or someone you trust. You can also call MEDICARE ( ) or your State Health Insurance Assistance Program for help. TTY users should call Sincerely, Mark McClellan, M.D., Ph.D. Administrator Centers for Medicare & Medicaid Services Para obtener una copia de este aviso en español, llame gratis al MEDICARE ( ). Los usuarios de TTY deben llamar al

3 Important Questions and Answers about Your New Drug Coverage What should I do now? Read the materials your plan sends you about the drug plan Medicare will enroll you in if you don t join a plan by December 31, If you don t like the plan Medicare will enroll you in, you can get information about the other Medicare drug plans available in your area, including plans for which you pay no premium. Compare the plans and join a Medicare drug plan that works for you. You should find out which plans cover the prescriptions you take and what pharmacies you can use to fill prescriptions. You can begin enrolling in a drug plan November 15, Remember, if you don t join a plan by December 31, 2005, Medicare will enroll you in a plan. To learn more about other Medicare drug plans available in your area look at on the web and get personalized drug plan information. If you don t have a computer, your local library or senior center may be able to help you look at this information. call MEDICARE ( ) for a list of the specific plans. TTY users should call call your State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling. See your copy of the Medicare & You 2006 handbook or call MEDICARE for their telephone number. look for Medicare-related events in your community. Look for information about events in your local newspaper or listen for information on the radio. What is Medicare prescription drug coverage? Medicare prescription drug coverage is insurance. Private companies will provide the coverage through Medicare drug plans. There may be many Medicare drug plans available in your area to choose from. Medicare drug plans will help you pay for both brand-name and generic drugs you need. Most plans will have a list of drugs covered by the plan. The drug list may not include your specific drug. However, in most cases, a similar drug that is safe and effective should be available. Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient to you. Some plans also allow you to get your prescriptions through the mail. What are the differences between Medicare and Medicaid? Medicaid is the program in your state that pays health care costs for people with limited income and resources. It may be called something different in your state. Medicare is the federal health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. Medicare will continue to help pay for your health care costs. And if you continue to be eligible for Medicaid, Medicaid will still pay for your health care costs that Medicare doesn t cover (including prescriptions in some limited cases). If you aren t sure if you are still eligible for Medicaid, contact your state Medicaid program to find out.

4 Can I keep my Medicaid drug coverage? No. As of January 1, 2006, Medicaid will not continue the drug coverage it currently provides. Some state Medicaid programs may cover the few prescriptions that won t be covered under Medicare prescription drug coverage. But even if your state Medicaid program covers a few prescriptions, this coverage alone won t be as good as standard Medicare prescription drug coverage. What if I have other prescription drug coverage, besides Medicaid? If you have, or are eligible for other types of prescription coverage, read all the materials you get from your insurer or plan provider. Examples of other types of prescription drug coverage include coverage from an employer or union, TRICARE, the Department of Veteran s Affairs, or a Medigap policy. Talk to your benefits administrator, insurer, or plan provider. You may not need to join a Medicare drug plan. Note: Prescription drug coverage does NOT include doctor samples, discount cards, Medicare approved discount cards with or without the $600 credit, free clinics, or drug discount websites. Can I join a different Medicare drug plan? Yes. Even if you don t join a Medicare drug plan by December 31, 2005, and Medicare enrolls you in a drug plan, you can switch plans any time, with the new coverage effective the next month. If you want to learn about other plans you can join, call MEDICARE ( ) or visit for information about other Medicare drug plans available in your area. Plans vary; however, there are many plans available in which you would pay no premium. There are other plans where you may have to pay a premium. Be sure to ask about the premium when you are comparing plans. You can also call your State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling. To join a different Medicare drug plan, call the new plan to find out how to join. Joining a different plan will disenroll you from your current plan. Note: If you join a different plan, you may have to pay a small monthly premium instead of $0. If you decide to join a different plan that has a higher advertised premium, you may have to pay the difference in the cost of these two plan premiums yourself. What if I don t want Medicare prescription drug coverage? If you don t want to join, and you don t want Medicare to enroll you in a Medicare drug plan, call MEDICARE and tell them you don t want to join. But, keep in mind that you pay nothing to stay in the plan. If you drop this coverage and need prescription drugs, Medicare will not pay until you join a plan. If you keep this plan or join another, you have peace of mind knowing the coverage is there if you need it. However, if you tell Medicare you don t want to join a Medicare drug plan, you could have no prescription drug coverage as of January 1, You can change your mind and join a Medicare drug plan at any time, but you may have to pay a penalty if you join after May 15, CMS Pub. No October 2005

5 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 200 Independence Avenue, SW Washington, DC Office of External Affairs MEDICARE FACT SHEET MEDICARE OUTLINES STEPS TO HELP DUAL ELIGIBLES MOVE TO COMPREHENSIVE MEDICARE DRUG COVERAGE 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 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: o 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. o In October, all Medicare beneficiaries received the Medicare & You 2006 handbook. o 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 MEDICARE to determine a participating pharmacy. -- more --

6 Helping Dual Eligible Beneficiaries Make an Informed Choice 2 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 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 zeropremium 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 MEDICARE. They, a counselor or caregiver can also get the same material at 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 MEDICARE or they or a caregiver uses 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. -- more --

7 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: o 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. o 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. o Require Medicare prescription drug plans to include information about plan premiums in their pre-enrollment materials. 3 ###