MEDICARE D FOR 2008

Remember that Medicare Part D open enrollment began on November 15 and ends on December 31 for coverage effective on January 1, 2008.

Changes effective 2008:

• Standard deductible will increase to $275 from $265 last year
• Total drug cost limit at which donut hole begins will increase to $2,510 from $2,400 last year
• Total out-of-pocket cost for beneficiaries will increase to $4,050 from $3,850 last year before accessing catastrophic level of coverage. Out- of- Pocket costs include co-payments, coinsurance and deductibles but NOT premiums.

MA Stand –Alone Prescription Drug Plans (PDPs)

• In 2008, there will be 51 PDPs in Massachusetts.
• The lowest premium plan for 2008 is $14.60 (First Health Part D-Secure) and the highest premium plan is $99.50 (EnvisionRx Plus Gold).
• 31 of the PDPs offer a $0 deductible
• 7 of the plans cover all generic drugs in the “donut hole”. 8 more have some level of generic coverage in the donut hole.

Re-Determinations for those who no longer automatically qualify for LIS in 2008:

People automatically qualify for LIS (Low Income Subsidy, also known as “Extra Help”) if they-

• Are eligible for both Medicare and Medicaid (full dual-eligibles),
• Get help from their state Medicaid programs to pay their Medicare premiums (partial dual), or
• Get Supplemental Security Income benefits without Medicaid.

In September 2007, Medicare sent notices to those individuals who will no longer automatically qualify for extra help in 2008. If people think they may still qualify for extra help based on their income and resources, they should fill out the application that was included with the notice, or visit www.socialsecurity.gov for information on how to apply.

Similarly, in August 2007, the Social Security Administration (SSA) mailed notices to some people who did not automatically qualify, but who had applied and qualified for extra help on their own, to instruct them to report any changes in their income and resources. These individuals were asked to complete a form called “Social Security Administration Review of your eligibility for extra help” and return it to the SSA within 30 days.

NOTE: Individuals who were not selected for a review will not receive anything from the Social Security and there will be no change in the amount of extra help they receive.

Plan reassignment for LIS eligibles in 2008:
About 1.6 million LIS beneficiaries who got full premium subsidy in 2007 will be reassigned to a different plan in 2008 because their current plan is leaving the Medicare Program or the plan’s premium is increasing above the national benchmark level.
Medicare started mailing notices to these individuals in early November. There are two versions of the notice:

1. For people whose plans are leaving the Medicare Program: These people will be reassigned to a new plan regardless of whether they originally joined a plan on their own, or Medicare enrolled them in a plan.
2. For people on plans whose premium is increasing above the benchmark: Only those people who were enrolled in a plan by Medicare will be reassigned, NOT those who joined plans on their own or switched to a different plan than the one Medicare enrolled them in. If these people stay in their current plan, they would have to pay the difference in premium.

- Adapted from “Part D 2008 Update” e-mail from Pragya Rizal, Partners Community Benefits, November 27, 2007.

11/07