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Understanding LIS: Extra Help for Medicare Eligible Individuals

Join the National Medicare Training Program audio-conference to learn about CMS strategies and objectives for 2008, prescription drug coverage, and changes for people eligible for the Low-Income Subsidy (LIS). Discover how to make informed decisions and apply for Extra Help. Stay informed about eligibility, costs, and ongoing eligibility reviews. Be prepared for potential changes in your Medicare coverage and find out how CMS reassigns beneficiaries to new Prescription Drug Plans.

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Understanding LIS: Extra Help for Medicare Eligible Individuals

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  1. Helping People Eligible for Extra HelpWhat You Need to Know about LIS National Medicare Training Program Audio-conference Training September 26, 2007

  2. Today’s Topics • CMS strategies and objectives for 2008 • Overview of prescription drug coverage • People with changes in 2008 • Audiences • Target messages • Actions • Resources

  3. CMS Strategies • Annual enrollment period begins November 15 • Year-round efforts to reach people with low-income • Some will have changes for 2008 • LIS eligibility • Plan enrollment • CMS specific focus • Those potentially eligible for LIS • Those with LIS who face changes in 2008 premiums • July 2007 document describes our plans

  4. Looking at 2008 • Review and select plans during the annual enrollment period • Greater number facing changes in 2008 • Some face increase in premium if they remain in current plan • 1.5 million will be reassigned to a new plan

  5. CMS Objectives • Work with partners to help people • Understand coverage and options • Prepare for changes in 2008 • Make confident and informed decisions

  6. Prescription Drug Coverage and Extra Help

  7. Prescription Drug Coverage • Coverage began January 1, 2006 • Available for all people with Medicare • Provided through • Medicare Prescription Drug Plans • Medicare Advantage Plans and other Medicare plans

  8. Prescription Drug Costs • Costs vary by plan • Most people will pay • Monthly premium • Deductible • Copayments or coinsurance • Very little after • $3,850 out-of-pocket in 2007 • $4,050 out-of-pocket in 2008 • Extra help for people with limited income and resources

  9. Extra Help • Eligibility determined by SSA or state • Some groups are automatically eligible • People with Medicare and • Medicaid • Supplemental Security Income only • Medicare Savings Programs • Everyone else must apply

  10. How to Apply for Extra Help • Multiple ways to apply • Social Security • Paper application • www.socialsecurity.gov • 1-800-772-1213 (TTY 1-800-325-0778) • State Medical Assistance office • Local organization • You or someone on your behalf can apply

  11. Costs for Those With Extra Help • Below Federal poverty level save over 95% • People with lowest income and resources • Pay no premiums or deductibles • Have small or no copayments • People with slightly higher income and resources • Have a reduced deductible • Pay a little more out of pocket

  12. Continuing Eligibility for LIS • CMS re-establishes eligibility each fall • Extra help continued or changed • Based on continued eligibility • Changes effective January 1 • Those automatically eligible for 2007 • Continue to qualify through December 2007 • People no longer eligible • Automatic status will end December 31, 2007

  13. Those With LIS Changes

  14. Those with LIS Changes • Loss of deemed status • Change in extra help copayment • Selected for review by SSA

  15. Deemed Status Changes • Two groups • Those who no longer qualify automatically • Those who qualify for 2008 but with a change of copayment level

  16. 1. No Longer Qualify for LIS • CMS letter in September GREY PAPER • No longer automatically qualify for LIS • As of January 1, 2008 • Application for extra help • Action • Apply for extra help • Social Security Administration Or • State Medical Assistance (Medicaid) office

  17. 2. Change in Copayment • CMS letter in early October ORANGE PAPER • Continue to qualify for extra help in 2008 • Copayment levels change January 1, 2008 • Action • Keep the notice • No action if information is correct

  18. Selected for Review by SSA • Social Security letter in September • Form 1026 • “Income and Resources Summary” sheet • Action • Return enclosed form within 30 days or extra help may terminate

  19. Reassigning to New PDP • Each fall, CMS reassigns LIS beneficiaries with 100% premium subsidy to a new PDP • PDP is terminating Or • PDP premium increase • $1 over regional LIS premium subsidy amount • Converting to enhanced benefit

  20. Plan Terminating • CMS letter in late October BLUE PAPERversion 1 • Current plan is leaving Medicare Program • Reassigned to new plan effective January 1, 2008 • Unless they join a new plan by December 31, 2007 • Action • Keep the notice • Compare new 2008 plan with others • Can choose to change plans

  21. Premium Increase • CMS letter in late October BLUE PAPERversion 2 • Current plan’s premiums increasing by more than $1 over LIS benchmark, or converting to enhanced • Reassigned to new plan effective January 1, 2008 • Unless they join a new plan by December 31, 2007 • Action • Keep the notice • Compare new 2008 plan with others • Can choose to change plans

  22. How CMS Reassigns • Attempt to find another plan • Same organization • No premium liability • Promotes continuity • Reassigned randomly if none available • With plan below LIS

  23. “Choosers” • LIS with 100% premium subsidy • Chose plan in 2006 or 2007 And • Have premium increase over $1 • CMS will conduct outreach • Will not reassign

  24. “Choosers” • CMS LIS letter in October • Premium is rising by more than $1 in 2008 • Responsible for paying a portion unless they join a new plan • Action • May want to look for a new plan • Compare current plan with others • Can choose to change plans • Early December is best time

  25. Potentially Eligible • Social Security letter in late November • To people in Medicare Savings Programs • Extra help available for drug plan costs • Action • Apply if you think you qualify for extra help • Get more information from Social Security 1-800-772-1213 (TTY 1-800-325-0778)

  26. Resources to Help You

  27. LIS Toolkit • CMS Outreach Strategy • Best practices from around the nation • Maps to find those who need help • Photo novellas • Practical tools for counselors • Other helpful resources

  28. Enrollment Toolkit • How to help • Basic Part D education • How current coverage works with Part D • Choosing and joining a plan • Extra help • Additional resources

  29. Enrollment Resources • Personalized web tools • On www.medicare.gov • Medicare Prescription Drug Plan Finder • Medicare Options Compare • Partner support • On www.cms.hhs.gov/Partnerships • Mailings to people with Medicare • Publications for partners • Toolkits

  30. Training Resources • Training on personalized web tools • Designed for different purposes/audiences • Drug Plan Finder Webinar • Videos • Online • www.cms.hhs.gov/NationalMedicareTrainingProgram • Includes links to materials mentioned here

  31. Important Dates

  32. Important Dates

  33. Important Dates

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