Reassignment of Low Income Subsidy (LIS) (Extra Help) Beneficiaries for 2013

Beginning in October the Centers for Medicare & Medicaid Services will begin their annual reassignment of Low Income Subsidy (LIS) (Extra Help) beneficiaries.

CMS will reassign those Low Income Subsidy beneficiaries who are in a stand-alone Part D drug plan (PDP) and (1) whose plan will be leaving the Medicare program in 2013, or (2) whose plan will begin charging a monthly premium which is higher than the benchmark premium for the beneficiary’s state. (A “benchmark premium” is the highest amount that Medicare will allow for a Part D premium for a Low Income Subsidy beneficiary. These are more fully explained in my previous posting, which also lists the benchmark premiums for each state for 2013.)

CMS will also begin reassigning Low Income Subsidy beneficiaries who are in a Medicare Advantage – Prescription Drug Plan (MA-PD) or a Medicare Advantage only Plan (MA-only) and whose Plan is either leaving the Medicare program altogether, or is reducing its service area so the beneficiary can no longer be enrolled. Very importantly, these beneficiaries will be NOT be reassigned to another Medicare Advantage Plan, but will be reassigned to a stand-alone Part D drug plan (PDP) and put into Original (fee-for-service) Medicare. Because many of these beneficiaries have no other health insurance, they may need to keep the protections of being in a Medicare Advantage Plan and to take action to enroll in one effective with January 2013.

And, of course, Medicare will not reassign any beneficiary who will be loosing their Low Income Subsidy in 2013. These beneficiaries must remember that they will no longer be able to switch their drug plans each month, which Low Income Subsidy beneficiaries are permitted to do, and need to make sure, during the annual open enrollment, that the plan they are in is the best one for them.

Some additional details about these reassignments will be helpful.

With regard to the reassignment of Low Income Subsidy beneficiaries who are in a stand-alone Part D drug plan (PDP), please note that in some instances Part D plans are allowed to voluntarily waive a difference between the benchmark premium and their premium, where this difference is small. ($2.00 or less; the so-called “de minimis” rule.) In these cases, CMS will not reassign the beneficiary. Therefore, you may see instances where a Low Income Subsidy beneficiary’s stand-alone Part D drug plan’s premium is slightly higher than the benchmark, but the beneficiary is NOT reassigned.

In addition, CMS will not reassign a beneficiary if the beneficiary chose to be in their stand-alone plan, even though its premium will be above benchmark in 2013. The thinking here is that the beneficiary took specific action to join the plan, and this decision should be respected. This, of course, applies only where their plan is continuing into 2013; if the plan is terminating, CMS will reassign the beneficiary.


And with regard to the reassignment of Low Income Subsidy beneficiaries who are in a Medicare Advantage Plan which is not renewing its Medicare contract or undergoing a service area reduction, CMS will reassign these beneficiaries into a stand-alone drug plan (PDP). There are two exceptions to this: (1) If the beneficiary is in a Private Fee for Service (PFFS) Medicare Advantage Plan that does not have drug coverage (MA-only), and is also in a stand-alone drug plan (PDP), the beneficiary will not be reassigned. (2) If the beneficiary is in an employer sponsored MA-only or MA-PD plan, the beneficiary will not be reassigned.

And just to be clear, these Medicare Advantage Plan reassignments are made only if the Plan not renewing its Medicare contract or undergoing a service area reduction, and NOT because the Plan’s premium for its drug benefit will exceed the Low Income Subsidy benchmark in 2013.

And, as indicated above, these Medicare Advantage Plan beneficiaries who are reassigned will be put into a stand-alone drug plan (PDP) and Original (fee-for-service) Medicare. If they wish, they may enroll in a Medicare Advantage Plan with drug coverage (MA-PD). (If they do this, of course, their reassignment to a stand-alone plan is voided.) Or they may they enroll in a Medicare Advantage only Plan (MA-only) without drug coverage; if they do so, they will remain in the stand-alone drug plan (PDP) they were reassigned to, unless they choose a different stand-alone plan.


Notices:  Both Plans and CMS have a role in notifying Low Income Subsidy beneficiaries affected by the reassignment process. But for right now, the end of September and the beginning of October, notices will go out from Plans that are not renewing their contracts with CMS or which (in the case of Medicare Advantage Plans) are reducing their service area. In addition, for those that are staying, they will be sending out the Annual Notice of Coverage, and, as appropriate, warning Low Income Subsidy beneficiaries that their premium will exceed the benchmark in 2013. And late in October CMS will begin sending out more specific notices to affected beneficiaries, but I will blog about that in a week or two.

The Part D Donut Hole in 2010, Part 2, The $250 Rebate

The Part D Donut Hole in 2010, Part 2, The $250 Rebate

Information has just come out from Medicare confirming what I blogged about concerning the $250 rebate that beneficiaries who are enrolled in Part D and who hit the “donut hole” in 2010. The donut hole, of course, is the payment band in the Part D prescription drug benefit in which you usually have to pay 100% of the costs of your medicines. (I say “typically” because a number of drug plans do pay limited amounts for some drugs in this band; for example, there may be some coverage for generics.) And it begins to apply after your total drug spending exceeds $2,830, and you have paid $940 out-of-pocket. Again, these figures can vary some plan-by-plan.

This new information indicates that you will automatically be sent a check for $250 if you have already hit the donut hole. And if you have not yet done so, but do hit it later this year, the check will automatically be issued to you. Checks will begin going out on June 10.

Some important points:

The $250 is a set, invariable amount. No matter how deeply or shallowly you fall into the donut hole, your rebate will be the same. “One size fits all.”

The $250 will not count as income for tax purposes. It’s tax free!

If you qualify for any level of Extra Help, you will not get this rebate.

The $250, in the form of a check, will be sent to you automatically by Medicare, not by your Part D drug plan. (The envelope it comes in will say “Medicare Part D”.)

You should absolutely not give anyone any information under any circumstances to get your $250 check. Apparently the scam artists that prey on seniors and the disabled have figured out this is an excellent way to extract critical personal information from you. If anyone calls asking for information, slam the phone down and call 1-800-MEDICARE.

If you believe you qualify for this check but you don’t receive it, you should first call your Part D drug plan and ask them to make sure that they have sent the correct information to Medicare that you have hit the donut hole. If this has been done properly, you should then call 1-800-MEDICARE and ask them to issue you your check.


I would be interested in getting feedback about how well this process works.