Medicare Part D - Part D Mailings

SPRING BRINGS GREEN LETTERS ABOUT MEDICARE PART D

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The Centers for Medicare & Medicaid Services (CMS) has distributed fact sheets and memoranda that describe the following letters about Medicare Part D. The letters are to be sent out at the end of March to certain groups of beneficiaries.

Facilitated Enrollment Letters

Individuals who are eligible for the low-income subsidy (LIS) (also known as “extra help”) but who have not already chosen a Medicare Part D prescription drug plan should look for a green letter from CMS. Like the yellow letters sent last fall to people who are dually eligible for Medicare and Medicaid, the green letters inform LIS-eligible beneficiaries that they have been assigned to a low-cost Part D plan. Prescription drug coverage will begin May 1 for these beneficiaries.

Letters were sent to:

People who are deemed eligible for LIS because they receive SSI but not Medicaid;
People who are deemed eligible for LIS because they receive benefits under one of the Medicare Savings Programs (MSP) (QMB, SLMB, QI); and
People who applied and were found eligible for LIS.

Medicare Advantage plan enrollees and people who get their drug coverage through a retiree health plan for which their employer or union receives a retiree drug subsidy will not receive a letter. CMS also will not send letters to residents of Connecticut, New York, New Jersey, Pennsylvania, and Illinois who were, or who will be, enrolled in a Part D drug plan by their state’s State Pharmacy Assistance Program (SPAP).

There are two versions of the letter, one for people who are eligible for the full low-income subsidy and one for people who are eligible for the partial subsidy. The letters inform individuals of the plan in which they will be enrolled if they do not take action before April 30, 2006, and tell them that they may call 1-800-Medicare if they want assistance in enrolling in a different plan. The letters also include information and telephone numbers for the low premium plans within each individual’s prescription drug plan region. The full-subsidy letter indicates that recipients pay no premium or deductible, have no doughnut hole, and pay up to $2 for generic drugs and up to $5 for brand-name drugs. The partial subsidy letter indicates the percentage of the premium the recipients will pay, that they will pay up to a $50 deductible, and that they will pay up to 15% of the cost of covered drugs.

Copies of the letters are available on the Center for Medicare Advocacy’s website at http://www.medicareadvocacy.org/FAQ_PartD.htm#resources.

Notice to Confirm Medicare Plan Choice & Duplicate Enrollment Concerns

CMS has instructed Part D plans to send a disenrollment letter no later than March 27, 2006, to some beneficiaries as part of each drug plan’s enrollment reconciliation process. These letters, developed by CMS, are supposed to confirm the beneficiary’s choice of Part D plan if CMS records indicate that the beneficiary is enrolled in two different plans. Duplicate enrollment may occur because a beneficiary enrolled in a new plan on his or her own or was enrolled in a new plan by someone else, including the state or a retiree health plan. The letters are only sent to enrollees who have used a drug plan, other than the plan in CMS’ records, to get prescriptions.

The letter from stand-alone prescription drug plans (PDPs) indicates the beneficiary has received prescription drug benefits from the plan but Medicare records show that he or she is enrolled in a different plan. The beneficiary is advised to call the plan that sent the letter by April 10 (or a later date if the plan can get the information to CMS by April 15) in order to remain in that plan. The letter either includes a phone number to call or tells the beneficiary to call the plan’s customer service number on the back of the membership card. If a beneficiary does not call the plan, the beneficiary will not be able to use the membership card for the plan. The letter also says that the beneficiary will be covered by the plan shown in the Medicare records and need not do anything to remain in that plan. The beneficiary is advised to call 1-800-Medicare if he or she is not sure of the plan in which he or she is enrolled.

A separate letter to be sent by Medicare Advantage plans with drug coverage (MA-PDs) indicates that the beneficiary has received Medicare prescription drug benefits or other Medicare services from the MA-PD, but Medicare records show that the individual is now enrolled in a different plan. The rest of the information is the same as in the PDP letter. The beneficiary must affirmatively contact the plan that sent the letter in order to remain in the plan.

Neither letter informs beneficiaries of the process to recover premiums if premiums from both plans have been deducted from the Social Security checks or if they have otherwise paid for two Part D plans.

NO Transition Process Letters

CMS reminded Part D plan sponsors in a March 17, 2006 memorandum that the initial transition period ends on March 31 for early Part D enrollees. The letter reiterates the importance of the transition process as a period for enrollees to work with their doctors to change to formulary drugs or to request a formulary exception and the need for enrollees to be given guidance on how to proceed after receiving a temporary fill of a prescription.

Unfortunately, CMS does not require plans to send written notices to their enrollees who received temporary fills during the transition period. Instead, CMS tells plans that they should consider contacting these enrollees to make sure they have the needed information. CMS also suggests that plans increase staff capacity to respond to an increased volume of Exception requests. If beneficiaries are not advised of their rights, however, they will not ask for Exceptions, or will not seek an Exception in advance of being denied a refill for a needed drug.