The following article was submitted by Carol Edwards, benefit specialist with the Aging Resource Center for Douglas County. The article was originally compiled for publication in The Specialist, a publication distributed to benefit specialists in Wisconsin by the Coalition of Wisconsin Aging Groups Elder Law Center.
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Many people who participated in the new Medicare prescription drug benefit, Medicare Part D, received assistance with their 2006 Part D costs through the Medicare Part D Extra Help program.
The Extra Help program provides assistance to individuals of limited means, helping them pay their Part D premiums, co-pays, and deductibles. Any beneficiary can apply for the Extra Help program, but only those who meet certain asset and income limitations are eligible to participate.
Certain beneficiaries are automatically eligible to receive yearly Part D help. Medicare beneficiaries who receive Medicaid benefits or beneficiaries who receive help from the state in paying their Medicare premiums are automatically eligible for the Part D Extra Help program. These beneficiaries do not need to apply for the Extra Help program.
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Every fall the federal agency that administers the Medicare program, the Centers for Medicare and Medicaid Services (CMS), determines which beneficiaries are automatically eligible to receive Extra Help for the following coverage year.
In August 2006, CMS began the process of determining who is automatically eligible for the Medicare Part D Extra Help program during the 2007 coverage year.
The state of Wisconsin will provide a list to Medicare of who is automatically eligible for Part D Extra Help assistance as of July 2006.
If a beneficiary's name is included on the list, that beneficiary will receive help with their Part D costs for the 2007 coverage year (starting January 2007). The beneficiary will receive a notice about continued eligibility for Part D assistance.
If you received help with your Part D costs, but no longer receive Medicaid benefits, or no longer receive help from the state in paying your Medicare premiums, you will not automatically be eligible for Part D assistance in 2007. Individuals who are no longer automatically eligible for the Part D Extra Help program will receive a notice from CMS alerting them to this change.
People who lose their automatic eligibility status can still receive help with Part D costs, but will have to submit an application for the Extra Help program to the Social Security Administration (SSA).
The Social Security Administration will determine their eligibility.
If a beneficiary becomes eligible for Medicaid benefits, or receives assistance from the state in paying for Medicare premiums, that individual will be automatically eligible for Part D help. Should a beneficiary begin to receive these benefits between now and December 2006, he or she will be found eligible for Part D assistance during the entire 2007 coverage year.
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The important point to remember is to watch your mail, especially if you are a person currently receiving assistance with your Part D plan costs. CMS will mail notices starting in August and continue mailing notices through the fall.
If you do not receive a notice by the time Part D re-enrollment starts on Nov. 15, 2006, contact Carol Edwards, benefit specialist at the Aging Resource Center for Douglas County, (715) 394-3611, or the CWAG Prescription Drug Helpline for Medicare beneficiaries at 1 (866) 456-8211.
