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MEDICARE PART D
10/5/2006 12:00:00 AM
MEDICARE PART D PLAN CHANGES
M E
M O R A N D U M
TO: Affiliate
Executive Directors
Clinic
Directors
Residential
Directors
Day
Services Directors
Service
Coordinators
FROM:
Deb Williams, Vice
President, Reimbursement & Regulatory Compliance
DATE: October
5, 2006
RE: MEDICARE PART D PLAN CHANGES
We
have just received information from the NYS Office of Mental Retardation and
Developmental Disabilities (OMRDD) regarding significant changes to the
benchmark prescription drug plans (PDPs) for dually eligible (Medicaid and
Medicare) consumers.
PDP CHANGES
As
you know, dually eligible consumers were initially auto-assigned to a benchmark
plan (a benchmark plan is a plan where the premium is $0). At this point, agencies
or consumers either
chose to stay in the auto-assigned plan, switched to another benchmark plan
with no cost to the consumer, or switched to a non-benchmark plan and paid the
additional cost for the premium.
With
the first year of the Part D program coming to an end, plans/companies have a
choice of staying in the program, leaving the program or making changes to
their benefits. Unfortunately, we have been informed that only 6 of the 15
original benchmark plans in 2006 will remain in the program for 2007 without
changes to their benefit structure.
Based
on the 2007 CMS plan listings for New York State, there will be a total of 13
benchmark plans available from 12 companies.
The
6 benchmark plans enrolled in 2006 that will continue in 2007 are:
1. American Progressive (Prescription
Pathway Bronze) (S5825-045)
2. Humana PDP Standard (S5552-003)
3. Simply Prescriptions (Excellus/FLRx) (S3521-001)
4. Unicare (Anthem/Medicare Rx Rewards Value
(S5960-003)
5. UnitedHealthcare (new AARP MedicareRxPlan
- Saver) (S5921-203)
6. WellCare Signature (plus new WellCare
Classic) (S5967-037/140)
Attached is an email from OMRDD providing more
detailed information about the plan changes.
NOTIFICATION TO BENEFICIARIES
Additionally,
the notification to beneficiaries regarding the changes in the plans as well as
reassignment of consumers to new plans could be problematic (see #3 below).
Following
are the processes for notification and reassignment:
1. If a PDP drops out of the Part D
program, CMS will reassign the individuals who are full subsidy eligible (dually
eligible individuals are full subsidy) to a new plan effective January 1,
2007. Reassignment letters will be sent out in early November on blue
paper.
2. If a PDP’s monthly premium cost does
not increase by more than $2 over the benchmark cost for 2007, full subsidy
eligible people will be allowed to stay in the same PDP and will continue with
no monthly premium for the plan. These individuals will not get a special
letter from CMS.
3. If a PDP’s monthly premium increases by
more than $2 over the benchmark cost for 2007, CMS will issue a reassignment
letter only if the person meets the following criteria: the person remains
full subsidy eligible for 2007 and the person was auto-assigned to a plan in
2006 and remained in the same plan. This letter will also be on blue
paper and mailed early in November.
Please note that in situation #3 above, any dual eligible who elected
a new benchmark plan in 2006 over the original auto-assigned plan, will not
automatically be reassigned to a new benchmark plan nor will they be notified if
the current plan’s monthly premium increases by more than $2 over the benchmark
for 2007. They will be liable for the extra premium cost or can avoid extra charges
by switching to another fully subsidized benchmark plan.
Individuals
should carefully read their Annual Notice of Change letters from their plans.
As
we obtain additional information, we will be sure to provide it to you.
If you have any questions, please do not hesitate to contact me (518)
436-0178.
[Attachments can be obtained by contacting the Affiliates
Services Office at (518) 436-0178.]
