Transcript Extra Help” Redetermination of Eligibility

Medicare Update
for the
California Medicare
Coalition
Frank Van Nostrand
Public Affairs Specialist
October 4, 2006
Drug Coverage Enrollment
Enrollment Category
# Enrolled*
Stand-Alone Prescription Drug Plan
10.39M
Medicare Advantage with Prescription Drugs
6.04M
Medicare-Medicaid (Automatically Enrolled)
6.07M
Medicare Retiree Drug Subsidy
6.90M
Estimated Federal Retirees (TRICARE, FEHB)
3.46M
Additional Sources of Creditable Coverage
5.95M
TotalData as of 06.11.06
38.81M
Wealthier Seniors will Pay
More for their Part B in 2007
Beneficiaries who file an
individual tax return with
income:
Beneficiaries who file a
Joint tax return with
income:
Income Related
Monthly
Adjustment
amount
Total
Monthly
Premium
amount
Less than or equal to
$80,000
Less than or equal to
$160,000
$0.00
$93.50
Greater than $80,000 and
less than or equal to
$100,000
Greater than $160,000 and
less than or equal to
$200,000
$12.30
$105.80
Greater than $100,000 and
less than or equal to
$150,000
Greater than $200,000 and
less than or equal to
$300,000
$30.90
$124.40
Greater than $150,000 and
less than or equal to
$200,000
Greater than $300,000 and
less than or equal to
$400,000
$49.40
$142.90
Greater than $200,000
Greater than $400,000
$68.90
$161.40
Income Related
Monthly Adjustment
Beneficiaries who are married but
file a separate tax return from their
spouse:
Income-related
monthly adjustment
amount
Total monthly
premium
amount
Less than or equal to $80,000
$0.00
$93.50
Greater than $80,000 and less than
or equal to $120,000
$49.40
$142.90
Greater than $120,000
$67.90
$161.40
Basic Coverage in 2007
Beneficiary pays an estimated $288 in premium ($24 monthly)
Total
Spending
$265
$2400
$5451.25
$+
75 %
Plan Pays
$0
$1601.25
Bene Pays
$265
$798.75
about 95%
$1601.25
$3850
about 95%
5 % or
$2.15 & $5.35 co-pays
of higher
amounts
Are the Resource Limits for the
Extra Help program going up?

Yes!

But we don’t know how much yet..

They will be announced when the
Social Security COLA is announced.
Collection of Part D Premiums





Early August – Checks mailed to 230,000
beneficiaries
August 18 Letter - Acknowledges Error
August 31 – 2nd Letter – Asks for Refund
September 28 – Federal Court orders a
halt to collection
Overpaid individuals may request Waiver
“Extra Help”
Redetermination
of Eligibility
4 Types of Redeterminations

L1026

Subsidy Changing Event

Redetermination following report of
other event
 Cyclical
redeterminations
L1026 Redetermination

Started August 2006

Eligible for Extra Help 01/06 – 04/06

Only one L1026 redet per person/couple
4 step procedure

SSA-L1026 is mailed to individual



If no changes, no action required
If changes, return the form attached to the
letter
We will review and send out an SSA-1026REDE with income/resource summary.


Must be returned within 30 days
30 day extension may be requested
4 step procedure

If returned form shows a subsidy changing
event –


If no subsidy changing event –


case is sent to the field office
subject to verification
Any changes will be effective
January of following year
Exceptions to the L-1026

Individual reports an SCE


Individual reports another event


We will send an SSA-1026-SCE
We will send an SSA-1026-REDE
A match of agency data indicates the
current subsidy amount may be incorrect
Subsidy Changing Event






Marriage
Death of living-with spouse
Divorce of living-with spouse
Annulment of living-with spouse
Separation of living-with spouse
Resumption of living together with
previously separated spouse
SCE is reported


We will send an SSA-1026-SCE
If form is returned within 90 days, we will




If form is not returned within 90 days


Redetermine the subsidy amount, or
Terminate the subsidy, or
Determine that no change is warranted
Subsidy is terminated
Change is effective the month after the
report of SCE
Report of Other Event

If other event is reported before August


If other event is reported between AugustDecember


SSA-1026-REDE mailed out with cyclical
redeterminations
SSA-1026-REDE will be mailed immediately
Any changes will be effective January of
the following year
Cyclical Redeterminations

Selected once a year



First year eligibles will receive a L1026
Only a portion of other eligibles will be
selected
We will mail an SSA-1026-REDE


Must be returned within 30 days
30 day extension may be requested
Cyclical Redeterminations

If returned form shows a subsidy changing
event –



continuing subsidy will be determined
change effective month after report
If no subsidy changing event –


subject to verification
any change in subsidy effective January of next
year
That’s All Folks!!