Center on Aging: Medicare Drug Information: Info for Professionals
Medicare Prescription Drug Information for Professionals
General Info - Helpful Tools - Physicians - Pharmacists - Social Services and Long-term Care Facility Staff
General Information
NEW MAILING TO MEDICARE RECIPENTS RECEIVING EXTRA HELP
CMS is working toward a smooth transition to ensure continued
prescription drug coverage for all Medicare beneficiaries who received
extra help in paying their prescription drug costs in 2007.
Specifically, CMS is taking several actions in order to reach out to the
beneficiaries receiving the low-income subsidy (LIS) who are facing a
change in their Part D premiums in 2008, including providing more
information to beneficiaries about these changes via two letters.
This fall, CMS is sending both the blue reassignment letter which was
sent last year and a NEW tan letter to beneficiaries receiving the LIS
who selected a plan, but who will be responsible for paying a portion of
their plan premium beginning in January 2008 unless they join a new
plan.
During the week of October 29, 2007 CMS will begin mailing the
following:
Re-assignment Notices (Blue): Medicare will mail re-assignment notices
to people who qualify for the full extra help and will be reassigned to
a new plan in 2008.
Some people will be reassigned because their 2007 Medicare Prescription
Drug Plan's premiums are increasing for 2008 (Publication No. 11209).
This includes about 1.16 million people who will be moved to a new plan
outside their current organization. The reassignment notice they receive
will provide information about three options: moving to the new plan,
staying in the current plan, or selecting a different plan. Details
about their new zero premium plan (including co-payment amount, and
yearly deductible) are provided, along with the name of their new
organization and a phone number that can be used to get additional
information about prescriptions covered, drug coverage rules (like prior
authorization), and local pharmacies that can be used. The notice also
provides information about the person's current plan, and a list of all
the zero premium plans in the area. An additional 965,000 people will be
moved to a new plan within their current organization. These people will
receive the same reassignment notice described above; the only
difference is that the name of their organization may remain the same,
even though their plan is changing.
About 1,550 people will be reassigned because their 2007 Medicare
Prescription Drug Plans are terminating (Publication No. 11208). This
notice specifies that their current plan is leaving and also provides
information about their new plan, and alternative options.
All reassignment notices are printed on blue paper and inform
beneficiaries that that they will be reassigned to a new plan if they
don't tell their current plan they want to stay or join a new plan on
their own by December 31, 2007.
NEW "Chooser" Notices (Tan): Medicare will mail chooser notices
(Publication No. 11267) to a total of about 442,000 people who qualify
for the full premium subsidy and who chose to join a Medicare Drug Plan
that was "free" (no premium liability) when they first joined, but whose
premium will be above the regional low-income premium subsidy amount by
more than $1 in 2008. To respect individual choice, Medicare does not
reassign LIS beneficiaries who joined plans on their own or switched to
different Medicare Prescription Drug Plans than the plan Medicare
enrolled them in. These letters are printed on tan paper and inform
beneficiaries what their out-of pocket payment will be in 2008, lists
the zero premium plans available, and provides a list of important
things to think about when considering plan options such as pharmacy
networks, drugs covered, and satisfaction with current plan.
The following materials related to these two mailings have been posted
to the Limited Income and Resources web page
<http://www.cms.hhs.gov/limited
<http://www.cms.hhs.gov/limited
* Guide to LIS Mailings for CMS, Social Security and Plans *
Re-assignment Data of Beneficiary Notifications by state, county and zip
code * Re-assignment Notice Sent to Those with a Plan Not Available in
2008 (blue) * Re-assignment Notice Sent to Those with a Premium
Increase in 2008 (blue) * Re-assignment Partner Tip Sheet - Information
Partners Can Use on: Re-assignment * Chooser Data of Beneficiary
Notifications by state, county and zip code * Choosers Notice Sent to
Those with Drug Cost Changes in 2008 (tan) * Links to other helpful
information, including locating local resources in your area
If you have any questions regarding this information, please feel free
to contact Nancy Schmidt, Centers for Medicare & Medicaid Services,
Region VII - Kansas City, (816)426-6519, nancy.schmidt@cms.hhs.gov
<mailto:nancy.schmidt@cms.hhs.gov>
PAYING MEDICARE PART C/D PREMIUMS
People with Medicare have two options for how they pay their Medicare
Part C/D plan premiums. One option is to have their monthly plan premium
deducted from their monthly Social Security payments. The second option
includes getting billed directly from the plan for monthly premiums. In
2006, some people had incorrect amounts (including none at all) deducted
from their Social Security payments. Many of these errors were corrected
during 2006. To correct the remaining 2006 errors, Medicare performed a
comprehensive premium withholding payment reconciliation process for
people who had Medicare premiums withheld from their Social Security
payments for their Medicare Advantage Plan or Medicare Prescription Drug
Plan at any point during 2006. As a result of this process, Medicare
found that some people who had premiums withheld during 2006 still have
unresolved issues related to the withholding.
Medicare is taking steps to resolve the issues related to the
withholding for all of these people.
The first attachment is a tip sheet that describes the different people
affected by the 2006 premium withholding reconciliation. In addition, we
have attached a copy of the letter being sent to beneficiaries who owe
money to their plan(s).
Feel free to contact us at (816) 426-5783 with any questions you may
have regarding this important information.
Thank you,
Lisa Goschen
Acting Associate Regional Administrator
Division of Medicare Health Plans Operations Kansas City Regional Office
Centers for Medicare & Medicaid Services
CENTERS FOR MEDICARE AND MEDICAID SERVICES
2007 Low-Income Subsidy(LIS) Toolkit, (July 2007, .pdf format). This toolkit providesimportant resources for partners to help beneficiaries learn about andapply for extra help (the low-income subsidy, or LIS). Please scrolldown to the bottom of the page for downloadable materials and helpfullinks for those that may need extra help paying for prescription drugs.http://www.cms.hhs.gov/Partnerships/Toolkits/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1188820&intNumPerPage=10
Advocates' Manual on Medicare Part D Appeals Available:
The Medicare Rights Center (MRC) has published a free, useful guide <http://capwiz.com/ncoa/utr/1/KZGWHANRUU/AHDSHANVPW/1153222661> to help advocates navigate the often cumbersome Part D appeals process. The guide provides step-by-step instructions on how to accurately file an appeal and protect a client's rights. It also has examples in the back to illustrate common situations that may arise through the e appeals process.
CMS
Updated Information on Patient Assistance Programs PAPs can provide assistance to Part D enrollees and interface with Part D plans by operating "outside the Part D benefit" to ensure that Part D benefits and PAP assistance are provided separately. PAP assistance does not count towards a Part D beneficiary's true out-of-pockets cost (TrOOP), which determines whether an individual has reached the threshold for catastrophic coverage under the Part D benefit.
The information posted on the CMS’ Web site includes CMS's Coordination of Benefits guidance, PAP Data Sharing Agreement documents, an Outside the Benefit Q&A, and the PAP Attestation document. These documents can be found at the following Web site: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/07_PAPData.asp#TopOfPage. CMS plans to update these resources on a regular basis.
Medicare's New Open Enrollment & Partner Center
STATE BY STATE MEDICARE PART D PLANS:
The list of national plans can be found at www.medicare.gov/medicarereform/local-plans-2007.asp , www.medicare.gov/medicarereform/local-plans-2007.asp. At the bottom of that page, a link to the 2007 source PDP Excel file is provided
Out of Pocket Costs
What Are “True Out-of-Pocket” Costs Under the Medicare Prescription Drug Benefit?
This fact sheet explains the relationship between True Out-of-Pocket costs and the Medicare drug plan deductible, coverage gap and start of catastrophic coverage for those with very high prescription drug costs.
Understanding Changes in Prescription Drug Coverage for People with Disabilities on Medicare
This guide provides information for people with disabilities, benefits counselors, disability organizations and others on transitioning to the Medicare Part D Prescription Drug Benefit.
Guide to the Medicare Part D Appeals Process2007-11-15 11:43lth Assistance Partnership's fact sheet on appealing a prescription drug plan's decision to deny coverage contains information on how to request a "formulary exception."
Resources
Iowa’s Senior Health Insurance Information Program (SHIIP)
For objective, one-on-one, help in comparing Medicare drug plans, SHIIP can be contacted statewide at 1-800-351-4664. For a list of local counseling sites throughout Iowa, click here. For contact information for SHIP programs in other states, click here.
Access to Benefits Coalition (ABC)
Iowa Contact Information
The Access to Benefits Coalition, sponsored by the National Council on the Aging, is working in Iowa and throughout the nation to educate people with Medicare and others about the new Medicare prescription drug program. The Heritage Area Agency on Aging, based in Cedar Rapids, is a contact for Iowa.
Kaiser Family Foundation Part D Drug Benefit
The Kaiser Family Foundation's (KFF) website contains a wealth of background information on the Medicare prescription drug benefit including survey reports, fact sheets and white papers. Notably, KFF found that more than forty percent of respondents to a survey would turn first to their physicians for information about the new Medicare prescription drug program.
http://www.kff.org/medicare/rxdrugbenefit.cfm
http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=33325
http://www.kff.org/medicare/factsheets.cfm
KAISER FAMILY FOUNDATION "RESOURCES ON THE MEDICARE PRESCRIPTION DRUG BENEFIT" WEBSITE UPDATE.- Links to "Survey of Seniors and the Medicare Prescription Drug Benefit" (December 2006, .pdf format, chartpack, 20p., toplines, 33p.) and "Medicare Prescription Drug Benefit" (November 2006, .pdf format, 2p.) have recently been added to this meta-page.
http://www.kff.org/medicare/rxdrugbenefit.cfm
Sign up for Medicare's prescription drug program ListServs for pharmacists, nursing facility staff and others.
Consumer Reports, Best Buy Drugs
This website contains reports that describe and compare "Best Buy Drugs" in the following drug classes: ACE Inhibitors, Antidepressants, Beta-Blockers, Calcium Channel Blockers, Non-Steroidal Anti-Inflammatory Drugs (NSAID), Proton Pump Inhibitors (PPI), and Statins.
Health Assistance Partnership - Medicare Modernization Act Resource Center
The Health Assistance Partnership’s website contains helpful analysis and links to CMS regulations and policy guidance related to the Medicare prescription drug program.
Medicare Mailings and Any Action That May Be Needed
This chart explains the mailings that Medicare beneficiaries will be receiving and any action, if any, that they need to take. Also included in the chart are the links to the documents.
Iowa’s Senior Health Insurance Information Program (SHIIP)
For objective, one-on-one, help in comparing Medicare drug plans, SHIIP can be contacted statewide at 1-800-351-4664. For a list of local counseling sites throughout Iowa, click here. For contact information for SHIP programs in other states, click here.
Access to Benefits Coalition (ABC)
Iowa Contact Information
The Access to Benefits Coalition, sponsored by the National Council on the Aging, is working in Iowa and throughout the nation to educate people with Medicare and others about the new Medicare prescription drug program. The Heritage Area Agency on Aging, based in Cedar Rapids, is a contact for Iowa.
Kaiser Family Foundation Part D Drug Benefit
The Kaiser Family Foundation's (KFF) website contains a wealth of background information on the Medicare prescription drug benefit including survey reports, fact sheets and white papers. Notably, KFF found that more than forty percent of respondents to a survey would turn first to their physicians for information about the new Medicare prescription drug program.
http://www.kff.org/medicare/rxdrugbenefit.cfm
http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=33325
http://www.kff.org/medicare/factsheets.cfm
KAISER FAMILY FOUNDATION "RESOURCES ON THE MEDICARE PRESCRIPTION DRUG BENEFIT" WEBSITE UPDATE.- Links to "Survey of Seniors and the Medicare Prescription Drug Benefit" (December 2006, .pdf format, chartpack, 20p., toplines, 33p.) and "Medicare Prescription Drug Benefit" (November 2006, .pdf format, 2p.) have recently been added to this meta-page.
http://www.kff.org/medicare/rxdrugbenefit.cfm
Sign up for Medicare's prescription drug program ListServs for pharmacists, nursing facility staff and others.
Consumer Reports, Best Buy Drugs
This website contains reports that describe and compare "Best Buy Drugs" in the following drug classes: ACE Inhibitors, Antidepressants, Beta-Blockers, Calcium Channel Blockers, Non-Steroidal Anti-Inflammatory Drugs (NSAID), Proton Pump Inhibitors (PPI), and Statins.
Health Assistance Partnership - Medicare Modernization Act Resource Center
The Health Assistance Partnership’s website contains helpful analysis and links to CMS regulations and policy guidance related to the Medicare prescription drug program.
Medicare Mailings and Any Action That May Be Needed
This chart explains the mailings that Medicare beneficiaries will be receiving and any action, if any, that they need to take. Also included in the chart are the links to the documents.
Consumer Protection, Scams & Fraud
Medicare FactSheet: Attacking Fraud and Abuse
Quick Facts about Medicare Prescription Drug Coverage and Protecting Your Personal Information
Medicare Beneficiaries Warned To Be Aware of Telephone Scams Surrounding New Medicare Drug Benefit
Quick Facts about Medicare Prescription Drug Coverage and Protecting Your Personal Information
Medicare Beneficiaries Urged to be on the Look-out for Fraud & Phone Scams
FALL 2007 MAILINGS TO BENEFICIARIES
Below are several items to assist the beneficiaries in your area. These include information about mailings to LIS beneficiaries, a fall outreach milestone timeline and 2007 mailings chart, and a MyHealth MyMedicare Training Update:
SSA Information on Redeterminations: SSA is in the process of mailing "SSA Review of Your Eligibility for Extra Help" redetermination notices to some beneficiaries who are currently receiving the low-income
subsidy. About 500,000 beneficiaries will receive this mailing beginning Monday, September 10, 2007. Beneficiaries must complete the enclosed form within 30 days and submit it to the Wilkes-Barre Data Operations Center in the enclosed pre-paid envelope for processing. If a beneficiary needs assistance, they should contact SSA at 1-800-SSA-1213 (1-800-772-1213) or their local SSA field office. If a beneficiary does not complete and return the form, eligibility for Extra Help may beterminated effective January 1, 2008. A facsimile of the cover letter and form is located at
http://www.ssa.gov/prescriptionhelp/SSA-1026B-OCR-SM-INST.pdf
http://www.ssa.gov/prescriptionhelp/SSA-1026B-OCR-SM-INST.pdf
http://www.ssa.gov/prescriptionhelp/SSA-1026B-OCR-SM-INST.pdf
http://www.ssa.gov/prescriptionhelp/SSA-1026B-OCR-SM-INST.pdf on the web.
Upcoming Mailing: The "Loss of Deemed Status Letter" (GREY Letter) (Pub. No. 11198) is scheduled to be mailed to beneficiaries starting the week of September 17, 2007. CMS, in coordination with Social Security, mails these notices to people who no longer automatically qualify for extra help as of January 1, 2008. The mailing includes an application for extra help with a postage paid envelope to return to SSA. More information and materials will be circulated next week.
2007 Fall Outreach Partner Milestone Timeline & 2007 Mailings Chart:
CMS has developed a 2007 Fall Outreach Partner Milestone Timeline that outlines major activities that will take place in the next five months. In addition, a 2007 Mailings Chart is available that provides an overview of materials people with Medicare may received from CMS, SSA and plan sponsors. Hyperlinks to these materials are referenced for your convenience. The documents are also available at
http://www.cms.hhs.gov/partnerships/downloads/2007OutreachPartnerTimeline.pdf
http://www.cms.hhs.gov/partnerships/downloads/2007OutreachPartnerTimeline.pdf
http://www.cms.hhs.gov/partnerships/downloads/2007OutreachPartnerTimeline.pdf
http://www.cms.hhs.gov/partnerships/downloads/2007OutreachPartnerTimeline.pdf and http://www.cms.hhs.gov/States/Downloads/mailings.pdf
http://www.cms.hhs.gov/States/Downloads/mailings.pdf
http://www.cms.hhs.gov/States/Downloads/mailings.pdf
http://www.cms.hhs.gov/States/Downloads/mailings.pdf
These documents will be updated with additional links as materials become available. These reference tools will help for your planning efforts and activities during the open-enrollment period. Together, we can provide Medicare consumers the assistance they need to enroll in a drug plan, make changes to health care and drug coverage and apply for extra help.
Save the Date: Training Update- The next presentation in the My Health. My Medicare. series of audio-conference training sessions sponsored by the Centers for Medicare & Medicaid Services (CMS) will be
held: Wednesday, September 26, 2007 1:30 - 2:30 p.m. CDT
Helping People Eligible for Extra Help
This training will focus on what you need to know about the Low Income Subsidy (LIS), including information to help those with changes in their LIS status or Medicare Prescription Drug Plans. We will review all information, including key letters beneficiaries will receive and actions that should be considered. Policy experts will be available to answer questions.
Call-in procedures
Dial toll-free: 888-989-9729
Pass code: NMTP
Resources
Download the PowerPoint slides and other resources for this session on
the morning of the call by visiting the National Medicare Training
Program website at www.cms.hhs.gov/NationalMedicareTrainingProgram
http://www.cms.hhs.gov\NationalMedicareTrainingProgram
http://www.cms.hhs.gov/NationalMedicareTrainingProgram
http://www.cms.hhs.gov/NationalMedicareTrainingProgram Find and click Audio-Conference Training
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio-Conference%20Training.asp
http://www.cms.hhs.gov/NationalMedicareTrainingProgram/10_Audio-Conference%20Training.asp in the menu on the left, scroll down to Downloads, and click on the Handouts for the date of the call.
If you have any questions concerning the above information, feel free to give me us a call at (816) 426-6519.
Nancy Schmidt
Centers for Medicare & Medicaid Services / Regional External Affairs /
Region VII - Kansas City/ Ph: (816)426-6519
e-mail: nancy.schmidt@cms.hhs.govmailto:nancy.schmidt@cms.hhs.gov
Helpful Tools
Medicare Email Reminders for Preventive Services
Centers for Medicare and Medicaid Services recently added new
functionality to help beneficiaries track their preventive services
eligibility and utilization. CMS now will send beneficiaries who have
provided their email address an email reminder when they are eligible
for one of their preventive services. We are hopeful that the
notification will encourage more Medicare beneficiaries to utilize the
preventive services that are covered by Medicare. For more information
about signing up for mymedicare.gov see our latest brochure: Step by
Step Instructions for Using Mymedicare.gov (English)
http://www.medicare.gov/Publications/Pubs/pdf/11297.pdf
Step by Step Instructions for Using Mymedicare.gov (Spanish)
http://www.medicare.gov/Publications/Pubs/pdf/11297_S.pdf
USING THE MYMEDICARE.GOV TOOL
This PowerPoint presentation is designed to assist professional providers in helping Medicare beneficiaries and other advocates learn about the newest product from the Centers for Medicare & Medicaid Services (CMS) called MyMedicare.gov.
This personalized website allows Medicare beneficiaries and their advocates access to information regarding their Medicare benefits, preventive services they qualify for, and links to other important information. We hope professional providers will use this presentation, complete with speaker's notes, to spread the word about this valuable new resource. To view this presentation, click here. If you have any questions about this presentation, please contact Natalie Myers at 816-426-6384 or at Natalie.Myers@cms.hhs.gov
CMS Toolkit for Health Care Professionals: Medicare Prescription Drug Coverage Materials for You, Your Staff and Medicare Patients
Contains posters, fact sheets and other materials for providers who want to take an active role in educating people with Medicare about the new prescription drug plans and benefits
Benefits Check Up Rx
This website will also offer a Medicare drug plan comparison help, along with an eligibility screening tool for other federal and state programs. (The plan comparison tool is not yet in operation)
Physicians
CMS’s web page for physicians contains links to resources on Medicare’s new prescription drug coverage program as well as general Medicare topics.
“Extra Help” Available for People with Limited Income
The Social Security Administration is accepting applications from people with limited income and resources for a program that provides “extra help” in paying for Medicare drug costs. Click here for eligibility and other information and access to an on-line application form.
Pharmacists
Part D Reference Guide for Pharmacists is Now Available
CMS’s web page for pharmacists contains links to many Medicare resources on the new prescription drug benefit
Includes policy guidance, outreach materials and a sign-up page for CMS’s electronic mailing lists
CMS FAQs on Medication Management Therapy
- How will therapy management be coordinated with other disease management efforts?
Medicare Fee-For-Service Provider/Supplier Enrollment Information
This link accesses CMS 855 forms to apply for Medicare provider certification and National Provider Identification (NPI) numbers.
CMS Final Medicare Part D Marketing Guidelines
American Society of Consultant Pharmacists (ASCP) Part D Reference Page
Iowa Pharmacy Association "Medicare UPdate" webpage
Extra Help for People with Limited Income and Resources
Online Applications: https://s044a90.ssa.gov/apps6z/i1020/main.html
CMS Releases List of Part D Beneficiary Mailings
CMS has recently updated the "Guide to CMS, SSA and Plan Mailings for Summer and Fall 2007." This guide provides an overview and timing for mailings beneficiaries may receive and the actions they should take when they receive the mailing. Pharmacists can use this guide as a resource to assist in outreach activities or as a reference if patients have questions regarding the letter they receive from Medicare or SSA. As a new feature, this year's guide includes a color key to the mailings to help you assist those who receive letters on colored paper. This material is available by clicking here <http://www.cms.hhs.gov/States/Downloads/mailings.pdf> and will be updated regularly to include new updates and hyperlinks to samples of the mailings as they are available.
CMS Asks Pharmacists to Help Ensure Plan Readiness...
In preparation for the transition to the 2008 Medicare Prescription Drug
benefit plan year, CMS has identified several Plan requirements that are
critical to making sure that beneficiaries continue to receive effective
drug coverage. CMS expects Part D Plans to provide accurate and timely
beneficiary enrollment and subsidy information, effectively address
increased call volumes from beneficiaries and pharmacies, and more, to
ensure the effective transition to plan year 2008. CMS sent the Part D
Sponsor Readiness Checklist
<http://www.cms.hhs.gov/Prescri
inessChecklist_09%2004%2007
performance expectations. Pharmacy partners should review the check-list
to be aware of Plan obligations and deadlines.
Social Services and Long-term Care Facility Staff
Medicare Prescription Drug Coverage: How Does It Affect Long-Term Care Residents in Iowa?
This six page Q&A addresses several issues about involving the Medicare drug plans facing nursing facility residents and staff.
The Health Assistance Partnership’s web site
This website contains many helpful tools and links for long-term care facility staff and residents.