TN 7 (10-09)

HI 03001.010 Facilitated Enrollment and Special Enrollment Period for Individuals Eligible for Extra Help (Low-Income Subsidy)

A. CMS actions

The Center for Medicare and Medicaid Services (CMS) takes special action to assist low-income beneficiaries with enrollment in Medicare Part D prescription drug coverage. CMS automatically enrolls full-benefit dual (Medicare + full Medicaid) eligibles with a prescription drug provider (PDP), effective the first day of the month of dual eligibility.

CMS facilitates enrollment in a PDP or a Medicare Advantage plan with prescription drug coverage (MA-PD) for other deemed and Extra Help eligible individuals. To accomplish this, CMS:

  • Permits a continuous Special Enrollment Period (SEP) for beneficiaries eligible for Extra Help, so that they may enroll with a PDP or MA-PD or change current enrollment at any time; and

  • Notifies unenrolled Extra Help eligibles of their options.

B. Facilitated enrollment process

1. Identification

Each month since March 2006, CMS identifies individuals who:

  • are found eligible for the subsidy;

  • were not previously selected for facilitated enrollment;

  • are not enrolled with a PDP or MA-PD;

  • do not belong to the State Pharmaceutical Assistance Program (SPAP) in Connecticut, Illinois, New Jersey, New York, or Pennsylvania (those SPAPs will enroll their members); and

  • are not covered by an employer or union plan that CMS has determined provides creditable coverage (i.e., prescription coverage at least equivalent to Part D coverage).

2. Notification

After identification, CMS notifies identified individuals to enroll in a plan on their own or to notify CMS that they do not wish to be enrolled (i.e., opt out) by the date cited in the notice, or CMS will enroll them. The notice also specifies the plan into which CMS will enroll them and the effective date of the enrollment. Generally, individuals should receive the notice at the end of the month in which they were identified by CMS and they have until the end of the following month to opt out.

For example, CMS identified the first group of individuals in early March 2006 and issued notices at the end of March giving them until the end of April to enroll on their own or opt out. If they did not enroll on their own or opt out, CMS enrolled them effective May 1.

C. Special enrollment period

Individuals eligible for Extra Help and those who are deemed eligible have a “rolling” SEP and can enroll or disenroll with a PDP at any time.

D. Late enrollment penalties

Extra Help beneficiaries and deemed subsidy eligibles are exempt from any late enrollment penalty.

E. Reference

HI 03001.001F, Description of the Medicare Part D Prescription Drug Program

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HI 03001.010 - Facilitated Enrollment and Special Enrollment Period for Individuals Eligible for Extra Help (Low-Income Subsidy) - 10/29/2009
Batch run: 10/29/2009