Medicare Prescription Drug Congress MMA and Medicaid Gale Arden Director, Disabled & Elderly Health Programs Group CMSO CMS October 2005 Part D: Medicare Prescription Drug Coverage (cid:131) Effective: January 1, 2006 (cid:131) Called “Medicare Prescription Drug Plans’ (cid:131) Eligibility for Part D • Must be entitled to Part A or enrolled in Part B (Have Medicare Card) • Voluntary 2 Joining a Plan • Medicare beneficiaries who want Medicare prescription drug coverage must choose a plan • Many people with limited incomes and resources will get extra help • Join November 15 – December 31, 2005 – Coverage begins January 1, 2006 • Join January 1 – May 15, 2006 – Coverage begins the month after you join • Join when first eligible, to pay lowest monthly premium – About $32/month in 2006 • Coverage and costs vary 3 How the Plans Work • Must offer basic drug benefit – Standard benefit • May offer supplemental benefits – Enhanced benefit • Can be flexible in benefit design • May begin marketing in October 2005 • Must follow marketing guidelines 4 Successful Transitions to Medicare Prescription Drug Coverage How will CMS ensure the Medicare prescription drug coverage will be appropriate for Medicare beneficiaries, particularly for vulnerable populations like the dual eligibles? 5 Providing Extra Help: Low-income Subsidy • Those with lowest incomes pay no premiums or deductibles; small or no copayments • Those with slightly higher incomes pay a little more • Some people will automatically qualify – Full benefit dual eligible; – SSI recipient; or – Medicare Savings Program • Others may have received an application from Social Security – Medicare beneficiaries with income below 150% FPL who meet an asset test 6 Ensuring Continuity of Coverage: Auto-Enrollment • Medicaid prescription drug coverage for full- benefit dual eligibles ends 12/31/005 • Full-benefit dual eligibles will be automatically enrolled in a prescription drug plan effective January 1, 2006 if they do not select a plan • Notices will be sent informing duals of plan they will be autoenrolled in late-October • Full-benefit dual eligibles have a SEP so that they change plans any time 7 Auto-enrollment – Timing of Events During October • CMS one-time notification to PDPs • CMS one-time notification to State Medicaid Agencies of those auto-enrolled into PDPs Late October • CMS mails notices to beneficiaries auto-enrolled into PDPs • Start monthly auto-enrollments November – December • State Medicaid Agencies send Notice of Action to full duals (that Medicaid coverage is ending for prescription drugs) December 31 • Last chance to change before auto-enrollment takes effect 8 Establishing Appropriate Safeguards • Drug Plan Qualifications – Access – Choice – Brand Name and Generic – Pharmacies – Affordable cost 9 PDP Organizations WA ME MT ND 16 VT 20 NH MN OR NY MA 18 WI 20 17 SD ID 17 MI CT RI 17 18 WY PA NJ 17 IA OH 19 NE DE 17 18 NV IL IN MD 16 17 UT WV DC VA 16 CO 16 KS MO 17 KY CA 15 15 NC 18 16 TN 16 OK SC 16 18 AZ NM AR 15 18 17 AL GA MS 18 15 TX LA 16 20 AK FL 11 18 HI 20 10