AUTO-ASSIGNMENT 

When will dual eligibles receive information about their new Medicare PDP?

CMS randomly auto-assigns all new dual eligibles to a PDP, and sends them or their representative payee a letter notifying them of the PDP to which they have been assigned.  Click here to see a PDF version of the letter, with an introduction and FAQs.  Dual eligibles, their caregivers, and representative payees should check their mail for this important notice from CMS.

What happens if a dual eligible does not enroll in a PDP?

If the dual eligible (or their legally authorized representative) does not enroll in a PDP of their choice, then the auto-assigned drug plan named in the letter from CMS will become the plan that is responsible for the prescription drugs for that individual.  

After receiving the CMS auto-assignment letter (see above), when will the dual eligibles be able to change to a different prescription drug plan (PDP)?

Starting on November 15, 2005, dual eligibles can switch from the CMS auto-assigned drug plan another PDP.  Dual eligibles can switch plans up until Dec. 31, to ensure that they have their choice of Medicare prescription drug coverage on January 1, 2006.

 To switch to another PDP, it is advisable to make the change as soon as it is known which plan will meet the individual’s needs.  Given that there is likely to be processing time involved in making the changes enrolling early to ensure continued prescription drug coverage is advised.

What happens if a dual eligible is auto-assigned to a prescription drug plan (PDP) that does NOT include the pharmacy that he/she has been using?

There are two ways to handle this situation.  Either the dual eligible needs to switch to another PDP, one which includes the pharmacy that he/she has been using, or the dual eligible needs to use a different pharmacy, one included in the current PDP’s network.

What happans if the average benchmark in your area decreases in a new plan year?

In 2007 there were lower than projected premiums.  In many states the cost of the average “benchmark” plan has gone down.  As a result, some dual eligibles are in drug plans for 2006 that will not be “at or below the benchmark” for 2007, i.e. they cannot enroll for a $0 premium for 2007.  For these dual eligibles, CMS is planning to automatically re-assign them to a new drug plan with the same sponsoring organization or with an identical formulary list in an attempt to avoid disruption.

However CMS will only reassign individuals who kept their original assignment.  If the person (or their representative) changed plans because it better met their needs and this plan is above benchmark CMS will NOT reassign the person.

What happens if a beneficiary has a change in their dual-eligible status?

There are some low-income Medicare beneficiaries who had dual eligible status in 2006, who will not in 2007.  These are individuals that prior to 2006 qualified for Medicaid in their state as a result high medical expenses and “spend-down” eligibility.  Most of these dual eligibles were automatically enrolled in a Part D plan for 2006.  For 2007 however, many will not have dual eligible status because they never reached the Medicaid “spend-down” level in 2006.  These individuals will need to send in a new application for the Medicare Part D “Low Income Subsidy” (LIS) in order to access affordable drug coverage for 2007 (in most cases, coverage with no monthly premium, no deductible, no gap in coverage and as little as $3 for a generic, and $5 for a brand name prescription).  Notices from CMS to these “deemed” individuals were sent by mail in October, with an LIS application and postage paid envelope.  For more information, click here:     

http://www.cms.hhs.gov/partnerships/downloads/11198.pdf
http://www.cms.hhs.gov/partnerships/downloads/LISRedeterminationQA.pdf