Medicare Update for the California Medicare Coalition

1. Medicare Updatefor theCalifornia MedicareCoalition Frank Van Nostrand Public Affairs Specialist October 4, 2006

2. Drug Coverage Enrollment Data as of 06.11.06

3. Wealthier Seniors will PayMore for their Part B in 2007

4. Income Related Monthly Adjustment

5. Deductible Coverage Gap 25 % Co-insurance Catastrophic Coverage Total Spending $265 $2400 $5451.25 $ + 75 % about 95% about 95% $1601.25 $1601.25 Plan Pays of higher amounts 5 % or $2.15 & $5.35 co-pays $798.75 $3850 Bene Pays Basic Coverage in 2007Beneficiary pays an estimated $288 in premium ($24 monthly) $0 $265

6. 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.

7. 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

8. “Extra Help”Redeterminationof Eligibility

9. 4 Types of Redeterminations • L1026 • Subsidy Changing Event • Redetermination following report of other event • Cyclical redeterminations

10. L1026 Redetermination • Started August 2006 • Eligible for Extra Help 01/06 – 04/06 • Only one L1026 redet per person/couple

11. 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-1026- REDE with income/resource summary. • Must be returned within 30 days • 30 day extension may be requested

12. 4 step procedure • If returned form shows a subsidy changing event – • case is sent to the field office • If no subsidy changing event – • subject to verification • Any changes will be effective January of following year

13. Exceptions to the L-1026 • Individual reports an SCE • We will send an SSA-1026-SCE • Individual reports another event • We will send an SSA-1026-REDE • A match of agency data indicates the current subsidy amount may be incorrect

14. 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

15. SCE is reported • We will send an SSA-1026-SCE • If form is returned within 90 days, we will • Redetermine the subsidy amount, or • Terminate the subsidy, or • Determine that no change is warranted • If form is not returned within 90 days • Subsidy is terminated • Change is effective the month after the report of SCE

16. Report of Other Event • If other event is reported before August • SSA-1026-REDE mailed out with cyclical redeterminations • If other event is reported between August-December • SSA-1026-REDE will be mailed immediately • Any changes will be effective January of the following year

17. 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

18. 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

19. That’s All Folks!!