It’s that time again – to get ready for Part D Annual Enrollment Period! Join us this month as we review the low-income subsidy (LIS)/Extra Help program for 2011. We'll go over LIS benefits in 2011 and review the redeeming, reassignment, and redetermination processes of current LIS folks that will take place this fall.

This training will be offered at three different times to suit your busy schedules. We encourage you to pass this invitation to others. The dates/times for this training are:

Tuesday, September 21, 2:00-3:30 pm ET - To register, click here
Wednesday, September 22, 2:00-3:30 pm ET - To register, click here
Wednesday, September 29, 2:00-3:30 pm ET - To register, click here

Presentation slides - Coming Soon!

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Please think before you register. We have 150 audio lines available for each training and sometimes they fill up quick and as a consequence we have to turn people away from our live sessions. Yet we typically have 50 to 75 “no-shows” for each webinar. We ask that you carefully consider whether or not you think you will actually be able to attend a webinar before you register. Thank you for helping us to accommodate as many people as possible.

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Please contact abctraining@ncoa.org if you need further assistance.Visit us on the web at www.centerforbenefits.org.

The 2011 Part D regional low-income benchmark amounts have been announced! Now you can find out the regional benchmark amount for your state and begin to get ready to counsel your clients with 2011-specific info.

Why is the regional benchmark amount important?
The regional benchmark amount is the maximum premium subsidy that can be provided to full low-income subsidy (LIS)/Extra Help beneficiaries. People who get the full subsidy and are enrolled in a standard plan with a premium at or below the benchmark amount do not have to pay a Part D premium. If they enroll in a standard plan in which the premium is above the benchmark, they’ll have to pay a part of the premium.

Note: If your full subsidy clients enroll in an enhanced plan, they must pay the portion of the plan premium attributed to the enhanced benefit, even if the total plan premium is below the benchmark amount.

National Average Premium and the Part D Late-Enrollment Penalty Premium
The national average premium plays a part in determining the Part D late-enrollment penalty premium. In 2011, the national base beneficiary amount is $32.34. This is the amount the Centers for Medicare & Medicaid Services (CMS) will use when calculating a Part D late-enrollment penalty premium in 2011. Learn more about the late-enrollment penalty here.

What is the “de minimis” policy and how does it relate to the low income premium benchmarks?
For 2011, standard plans have the option to waiver for full LIS members a “de minimis” amount of the Part D premium that exceeds the benchmark. For 2011, the de minimis amount is up to $2 above the regional benchmark amount. This means standard plans in 2011 that employ the de minimis policy will continue to be premium-free to their members with the full LIS. Plans that agree to the policy must tell CMS by August 23 if they plan on participating for the 2011 plan year. They must waive the de minimis amount (up to $2) for all of their members who have the full subsidy in the 2011 plan year.

The intent of the de minimis policy is to allow full-LIS clients who to stay in their current plan if they so choose and to avoid the disruptions they might otherwise experience through reassignment or though having to switch on their own to a new Part D plan. Because people with full-LIS who are currently enrolled in a plan that participates in the de minimis policy for 2011 will not be reassigned in 2011, they will not get a reassignment letter.

For more info from CMS on the de minimis policy, see CMS’s April 5, 2010, Memorandum to all plans, entitled: Announcement of Calendar Year (CY) 2011 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter

You can also read statute on the “de minimis” policy - see Section 3303 (pages 926 through 928) of the Patient Protection and Affordable Care Act (H.R. 3590).

Will this affect reassignment?
With the recent health care reform provision that requires an improved calculation of the regional benchmark, and reinstatement of the de minimis policy, CMS estimates the number of reassignments to be 500,000 in 2011 (compared to 1.2 million who would have had to be reassigned without the new rules enacted in health care reform). Reducing the disruption of reassignments is a significant win for people with limited income and resources getting help with their Part D costs.

CMS will continue to reassign those people who qualify for full-LIS in 2010 and who were auto-enrolled into a benchmark plan at any time that is no longer a benchmark plan in 2011. CMS will send these people a blue letter the first week of November letting them that their plan premium has gone up, and if they remain in the plan, they will have to pay a portion of the premium in 2011. And, for the first time since Part D began in 2006, CMS will mail them a second letter (again, blue) the end of December that includes a side-by-side comparison of their current plan’s formulary and the formulary of the plan they will be reassigned to if they do nothing by December 31, 2010. This way, your clients can see which of their current drugs will not be covered under the new plan, and which of their current drugs may have a prior authorization or step therapy imposed on them under the new plan. (The letter will also include their appeals rights.) Your clients can use the comparison information to help them decide if staying in their current plan, and paying a small out-of-pocket premium, is better than taking the reassignment. Your clients may need your help reviewing this, along with any other plans available to them in 2011.

Note: CMS should disclose in September 2010 which plans are above the benchmark, which plans chose not to participate in the de minimis policy, and which plans are non-renewing for 2011. We expect to learn and share more information on the reassignment numbers once this information is made available.

CMS will also continue to reassign people who continue to qualify for the full subsidy in 2011, both auto-enrollees and choosers (people who picked a plan other than the one CMS assigned them when they were first eligible for LIS), whose plan is non-renewing for 2011. These people will get a slightly altered version of the blue letter in November letting them know that their current plan is terminating, along with info about the plan they will be auto-enrolled should they do nothing by December 31, 2010.

CMS will not reassign qualifying choosers whose plan in 2011 is above the benchmark or did not participate in the de minimis policy. These people instead will get a tan letter in early November letting them know they will have to pay a premium in they remain in the plan. CMS also will not reassign people who get the partial subsidy in 2011, or those who are no longer eligible for full subsidy in 2011. CMS expects to finalize all its mailing by mid-September. We’ll share those model notices as soon as CMS makes them available.

Finally, CMS expects to have general plan info available on the Medicare Plan Finder tool on October 2 and plan-specific info will be live around October 8th, so now is the time to get going on finalizing the tools you’ll use to counsel in your community on Part D plan selection.

Redeterminations and Redeeming of LIS eligibility for 2011 - Update from Social Security
Redeterminations and redeeming of the low-income subsidy (LIS), or Extra Help, program for 2011 are underway. Later this month around 400,000 people who applied for LIS/Extra Help through Social Security Administration (SSA) since May 2009 will have their eligibility for LIS/Extra Help redetermined. They will get a redetermination form from SSA and have a limited time to return it to SSA.

After the redetermination is completed, SSA will send them a notice informing them of their LIS/Extra Help status for 2011, whether it's no change from 2010; an increase or decrease in the level of their LIS/Extra Help; or termination of their LIS/Extra Help.

We'll keep you posted on number of people redeemed for 2011 as the info is made available. In the meantime, you can learn more about the redetermination and redeeming process here. Also, be sure and use the most current LIS/Extra Help application. Using the old application causes delays since SSA has to follow up with the applicant to get authorization to transmit the beneficiary’s data to state Medicaid offices to be reviewed for Medicare Savings Programs (MSPs) eligibility.

Summer Webinar Series on Appeals
Did you miss our early summer webinars? No worries! Check them out here:

June Webinar – What Benefits Counselors Should Know about Medicare Savings Programs (MSPs) & Low-Income Subsidy (LIS) Appeals
July Webinar - What Benefits Counselors Should Know about Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) Appeals

Upcoming Training Opportunities
Check out two upcoming webinar opportunities from the National Center for Benefits Outreach and Enrollment:

What Benefits Counselors Should Know about Medicare Parts A & B Appeals - Aug. 27, 30 & 31
This month, we’ll take a look at Medicare Parts A and B appeals and the role of benefits. Learn more about this webinar and register here.

For Benefits Counselors: How to Give Seniors Straight Talk on Health Reform - Sept. 13 & 16
Want to give your community the straight talk on health care reform for people with Medicare? Here’s your chance to get a Train the Trainer approach to the National Council on Aging (NCOA) just-the-facts approach to educating seniors and adults with disabilities about what’s in health care reform for them. To check out the Straight Talk for Seniors materials and to register for a webinar, clickhere.

Attached Files

2011-Regional-LIS-Benchmark-Amounts.pdf (62.3 KB)

In 2011 when you can disenroll from Jan 1 thru Feb 14th in a MAP it states you can enroll in a Part D Drug Plan. I assume that is only if the MAP you are disenrolling from included drugs. If you did not currently have drug coverage I would not think you would be eligible except during open enrollment Nov 15 - Dec 31 Please clarify.

Stay Up-to-Date on the Law That’s Changing Medicare
We’ve updated the PowerPoint presentation from the recent April Webinar on Health Care Reform and Your Clients to give you a concise review of the Affordable Care Act (ACA). Now you can learn exactly what changes are coming in 2011, 2012, and beyond for the Medicare program. Also available: a recording of the webinar and follow-up questions and answers. Access them now!

New Resources Help Educate Seniors about Health Reform
Many seniors remain confused about what health care reform means for them. The National Council on Aging’s Straight Talk campaign is helping to separate the myths from the facts. New campaign resources include a quiz to test your knowledge on health care reform, fact sheets on how the law affects Medicare Advantage plans, long-term care and Medicare financing, and a toolkit for aging services professionals. Download them here.

Websites Undergoing Revamp
Along with the new look of our MyMedicareMatters Update this week (see the version in your inbox on August 11), you can soon expect positive changes to our websites — MyMedicareMatters (our website for consumers) and MyMedicareCommunity (our website for professionals and benefits counselors). Both will offer a new, refreshed look and current information you need to help your clients. Stay tuned for these website changes (scheduled for release in mid-August).

In the meantime, let us know what you think of the new Update. We’ll be sending these on a bi-weekly basis now, on the second and fourth Wednesday of the month.

Other Resources from...

MyMedicareCommunity
Federal Poverty Levels (FPLs) Remain the Same in 2010
Download our updated LIS/Extra Help Eligibility and Subsidy chart.

MyMedicareMatters
Question of the Month
Check out this month’s question about the $250 Part D rebate check.

National Center for Benefits and Outreach Enrollment
August Webinar on Medicare Part A and B Appeals
Learn more and register here!

July Webinar on SNAP Appeals
Missed our webinar? No worries -- get follow-up questions and answers, along with a recording of the webinar, now available here.

Attached Files

2011-LIS Eligibility and SubsidyChart.pdf (26.9 KB)

When Your Clients Are Denied: What Benefits Counselors Should Know about Medicare Parts A and B Appeals

We’ll conclude our summer webinar series on the role of benefits counselors in appeals by looking at Medicare Parts A and B coverage disputes.

We'll address the following questions:

• How do I know when my client has received a Medicare Part A or B denial, service reduction or termination?
  
• How can I help my client decide whether to appeal a Medicare Part A or B denial, termination or reduction (or when informal advocacy might be a better route)?
  
• How can I make sure that my client understands and reaches informed decisions about how to proceed when problems arise?
  
• How can I help my client start an appeal and explain her rights and the appeals process to her?
  
• I'm not a lawyer! What community resources can help my client with an appeal?

We’ll also use case studies as part of this webinar.

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View the Power Point presentation here.

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Attached Files

August 2010_Medicare A B Appeals Webinar_For Posting.ppt (881.5 KB)