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Please scroll down to the bottom of the page for downloadable materials and helpful links. Please note the number in bracket next to a bold item in the page content corresponds to the downloadable item or link at the bottom of the page. {12} Act Now to Meet Prescription Drug Coverage Needs for 2008 CMS continues to encourage all Medicare beneficiaries to review their current health care coverage and ensure they are in a plan that will best meet their needs in 2008. Beneficiaries who wish to enroll for the first time or change their coverage for 2008 should do so as soon as possible to ensure a smooth transition in the New Year. The annual open enrollment period began on November 15th and runs through December 31st, 2007. {11} Special Enrollment Periods In certain situations, people with Medicare may be eligible for a Special Enrollment Period to join a plan that provides Medicare prescription drug coverage, or switch to a different plan. A Special Enrollment Period (SEP) is a period of time when an individual can enroll in or switch plans outside of the annual enrollment period (November 15th-December 31st). A chart linked to below describes the different situations in which an individual may be eligible for a Special Enrollment Period. {10} Information for People CMS will Reassign to a New Plan in 2007: In early November, Medicare re-assigned certain people who qualify for extra help into new Medicare Prescription Drug Plan for coverage effective January 1, 2007. For more information, please see the download section below. {9}Permissible Enrollment Subsets for Dual Eligibles Enrolled in Special Needs Plans Beginning with contract year 2008, Special Needs Plans (SNPs) may target enrollment of dual eligibles based on integration with State Medicaid efforts. Previously we permitted SNPs to target enrollment of dual eligibles based only on whether they were full benefit dual eligibles versus partial benefit dual eligibles. Our revised policy would permit SNPs to limit enrollment to groups of dual eligibles who are receiving their care under a Medicaid program, provided that the enrollment limitations parallel the structure and care delivery patterns of the Medicaid program, which is integrated with that being furnished with the SNP under Medicare. For more information, please see the attached memo. {8}State Medicare Part D Enrollment Profiles by Congressional District Attached are two state-level summary charts reflecting Part D enrollment as of June 11, 2006 by Congressional district. The first chart shows the number of beneficiaries with prescription drug coverage and the breakdown of coverage from Medicare or former employers as of June 11, 2006 by Congressional district. The second chart shows the Part D enrollment percentage increase from Jan 21 until June 11, 2006 by Congressional district. Please note that these data do not include individuals with other creditable coverage, such as through the Veteran's Administration, Indian Health Service, current employers for active workers with Medicare Secondary Payer, and other retiree coverage and State Pharmaceutical Assistance Programs. For these groups of people, the information is not available by congressional district. The statewide average percentage of those with other creditable coverage is noted in a footnote on each individual state table. {7}Announcement regarding Late Enrollment Penalties for Plan Year 2006 Please see the attached memo for more information on the late enrollment penalties for plan year 2006. {6}Enrollment Data Please click on the link below for enrollment figures by state, by county, and by number of prescription drug claims, and include figures for both standalone Medicare Prescription Drug Plans (PDPs) and Medicare Advantage Plans that include Medicare prescription drug coverage (MA-PDs). These figures are updated on a regular basis. This link also contains links to press releases regarding Medicare prescription drug coverage enrollment. {5}Updated Guidance On Facilitated Enrollments The purpose of this memo is to provide information and guidance about the following: - Conducting facilitated enrollments on a monthly basis
- Modifications to effective dates for facilitated enrollments
- Modifications to Exhibit 28, MA Model Notice to Inform Member of Facilitated
- Enrollment and Exhibit 29, Acknowledgement of Request to Decline Part D
{4}Auto and Facilitated Enrollment Guidance
The purpose of the two memos below are to provide information and guidance about the following:
•The first round of facilitated enrollment, effective May 1, 2006
•Effective dates for future auto-enrollment actions
•Retroactive enrollments for full-dual beneficiaries who have voluntarily enrolled in a PDP
•The monthly file of full benefit duals enrolled in MA plans Updated Guidance – Changes to Effective Date and PDP Notice Requirements for Auto-Enrollment and Facilitated Enrollment Updated Guidance – Changes to Effective Date of Medicare Advantage (MA) and 1876 Cost Plan Auto-Enrollments and Notice to Begin Facilitated Enrollment of Other LIS Beneficiaries {3}CMS Operational Guidance for PDP Enrollment and Disenrollment Auto-enrollment details are in Section 30.1.4. {2}CMS Operational Guidance for MA-PD Enrollment and Disenrollment Auto-enrollment details are in Section 40.1.6. {1}Auto versus Facilitated Enrollment This chart details the differences and similarities between auto and facilitated enrollment.
Page Last Modified: 12/14/2007 5:45:16 PM
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