The following is info from Medicare
Rights Center followed by info from Selfhelp Community Services on how EPIC will reassign
its members to Part D plans for 2008 during this 6-week enrollment period that begins
11/15/07.
As you know, EPIC will be reassigning many of its members who are enrolled in Part D.
You can find copies of the reassignment letters here: http://www.medicarerights.org/EPIC_Letters_50-55.pdf. EPIC has already sent out these letters, in addition to letters 56 & 57, which are the result of a second intelligent assignment that considers cost as well as plan restrictions. We do not yet have copies of these letters.
Here is a grid showing who will be reassigned: http://www.medicarerights.org/EPIC_Reassignment_2008.pdf.
Important points about EPIC reassignment:
· EPIC is reassigning all fee members in the plans highlighted in gray in the chart above.
· For the most part, EPIC is NOT reassigning people with Extra Help
· If you have full Extra Help and are in Humana Standard, you will be reassigned to Humana Enhanced (not sure if fee members without LIS will also be switched from Humana Standard to Humana Enhanced, or if they will be reassigned to a random plan)
· The letters tell people who are being reassigned which plan they will be reassigned to
· All fee members in WellCare Signature will go to WellCare Classic
· If you are going to be reassigned and want a different plan, you must call EPIC by Nov. 26th to say so (enrollment transactions will be sent to plans early December). Coverage starts January 1
· If you want to choose a different plan and you are in fee (non Low Income Subsidy (LIS)), EPIC will pay the full premium for benchmark or de minimis plans
Here is EPIC’s description of the process:
In developing the re-assignment plan, EPIC has tried to minimize the number of seniors who will be required to change plans. EPIC will be performing any needed reassignments for members, and EPIC has notified CMS that it will be responsible for reassigning all EPIC members.
EPIC will reassign over 70,000 members from the six Prescription Drug Plans (PDPs) losing benchmark status to the 2008 benchmark plans as follows:
· Fee members without LIS will be reassigned by EPIC to one of the 12 benchmark plans selected by EPIC based on their drug use and pharmacy needs. Members will have the option to remain in their current plan and pay the difference in premium, or select a different plan if they want.
· WellCare Signature seniors will be transitioned to WellCare Classic, which is a de minimis plan in 2008. The premium will be fully covered by EPIC and disruption to seniors will be avoided.
· Deductible members will be offered the option of being moved to a new benchmark plan selected by EPIC based on their drug use and pharmacy needs, or one of their own choice. If they do not exercise that option, they will remain in their current plan.
· WellCare Signature seniors will be offered reassignment to WellCare Classic, to avoid disruption.
Exceptions to Re-Assignment
· Members approved for the full or partial low-income subsidy (LIS), however, the Humana Standard seniors will be moved to Humana Enhanced, which provides a better benefit.
· Members currently enrolled in plans that will be benchmark plans in 2008 · Members currently enrolled in non-benchmark plans · Members in Medicare Advantage plans · Members currently not enrolled in Medicare Part D plans (e.g. those in union/retiree benefit plans)
Description of Letters Mailed
Letter R50 - Mailed to members with full or partial LIS notifying them that they can remain in their current plan for 2008 without any additional cost to them.
Letter R51 - Mailed to fee members notifying them that they will be reassigned to a benchmark plan for 2008 using the facilitated enrollment process (based on their drug usage and pharmacy needs). Members who want to remain in their current plan, or who want to select a different plan, need to call EPIC by November 26, 2007.
Letter R52 - Mailed to deductible members notifying them that their current plan’s premium will be higher than $24.18, the 2008 benchmark amount. However, the member will not be reassigned to a new plan unless they contact EPIC by November 26, 2007.
Letter R53 - Mailed to full or partial LIS members notifying them that they will be transitioned from Humana Standard in 2007 to Humana Enhanced in 2008.
Letter R54 - Mailed to fee members in WellCare Signature for 2007 reassigning them to WellCare Classic in 2008. The member must contact the EPIC Helpline by November 26, 2007 if they want to remain in WellCare Signature or request a different plan.
Letter R55 - Mailed to deductible members in WellCare Signature for 2007 who will be given the option to transition to WellCare Classic or a different plan. However, the member will not be reassigned to WellCare Classic unless they contact EPIC by November 26, 2007.
Dina Wizmur
Deputy General Counsel
Medicare Rights Center
520 Eighth Avenue, NW, 3rd Floor
New York, NY 10018
(212) 204-6227
SUMMARY CHART BY DAVID SILVA & SARAH STEEGE, SELFHELP COMMUNITY SERVICES, INC
EPIC and Reassignment
Extra Help Status
EPIC Status
Action Taken
Full Extra Help No EPIC
Possibly reassigned by CMS; see above bullets
Full Extra Help Fee EPIC
If currently in
Humana Standard, EPIC will reassign to Humana Enhanced
If in any other plan, they
will not be reassigned, because any premium increase will be absorbed by Extra Help + EPIC
subsidy
No Extra Help or Partial Extra Help
Fee EPIC
EPIC will use
intelligent random assignment to reassign them to a new plan with a premium less than
$25.18 (unless in Wellcare Signature, in which case they will be reassigned to Wellcare
Classic)
EPIC will also send letters to
some members whose 2007 plans are not going above $25.18 in 2008, reassigning them to a
new plan that better avoids utilization management than the one previously chosen by EPIC
in 2007
No Extra Help or Partial Extra Help
Deductible EPIC EPIC will not reassign them, but will send them a notice giving them
the option of switching to the plan chosen by EPIC using intelligent random assignment.
If they choose to remain in
their 2007 plan, then EPIC’s adjustment of their EPIC deductible will not fully
compensate them for their plan’s increased premium in 2008.
In any of the above scenarios where EPIC would use intelligent random assignment, EPIC will optimize coverage of brand-name drugs, the member’s preferred pharmacy, and lack of utilization management.
For complete list of 2008 plans see
2008 Plans
Annotated and Filtered Lists of 2008 Plans, including:
2008 PDPs for NY State;
2008 MA-PDs for NYC & Nassau County; and
2008 PDPs for NY State with No Premium for Full Extra Help recipients;
2007 PDPs and what will happen to them in 2008 (including new 2008 plans, and reassignment info.)
For more information on Medicare Part D 2008 Enrollment beginning 11/15/2007 – dsilva@selfhelp.net, ssteege@selfhelp.net, ddenney@selfhelp.net
Evelyn Frank Legal Resources Program
Selfhelp Community Services, Inc.
520 Eighth Avenue, 5th fl.
New York, NY 10018
tel 212.971.7693
fax 212.947-8737
vbogart@selfhelp.net
website www.selfhelp.net