EXTRA HELP (LOW INCOME SUBSIDY): PROCESS AND DETAILS

1. Those who no longer automatically qualify for Extra Help in 2007

There are approximately 630,000 individuals total in the U.S. and 16,000 in Massachusetts who were automatically qualified for extra help last year, but who no longer automatically qualify for LIS in 2007. Some examples- former duals who lost their MassHealth eligibility, or those who lost Medicare Savings Program benefits or those who lost SSI benefits.

• These individuals are encouraged to apply for LIS through the Social Security Administration, or the State Medicaid Office.
• Individuals who fall into this category will retain their prescription drug coverage, but may be liable for monthly premiums if they don’t apply and qualify for extra help on their own.

• These individuals are eligible for a three-month Special Enrollment period, as mentioned in accompanying story, through March 31, 2007 to help them switch to lower cost plans.

2. Reassignment of those receiving Extra Help due to premium increases

There are approximately 250,000 individuals total in the U.S. and 62 in Massachusetts who will be reassigned to a different plan in 2007 because their current plan’s premium increased more than $2 above the LIS benchmark in 2007. Only those individuals who qualified for extra help as of January 1, 2007 will be reassigned.

• Medicare won’t reassign individuals who joined plans on their own, or switched to a plan other than the plan Medicare enrolled them in, even if the plan’s premium in 2007 increased above the LIS benchmark.

Medicare will not reassign individuals who were enrolled in a plan by Prescription Advantage.

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