There is an alert sent to elder law attorneys that you might want to review if you are low income and are paying premiums for your Medicare Part D (Prescription) coverage:
Excerpts from the alert (available for download below):
"You May be Overpaying for Part D Prescription Drug Coverage"
"Every year hundreds of thousands of Medicare enrollees with the Low-Income Subsidy (LIS or “Extra" "Help”) overpay for Medicare prescription drug coverage. In 2021, for example, thirteen percent (800,000) of" "LIS enrollees were expected to pay an average of $27/month for Part D premiums in plan year 2022 if they did not switch to a premium free plan.
In many cases, the reason these individuals are paying premiums is inertia.
People who qualify for the full Medicare Part D LIS do not pay premiums if they enroll in plans with “benchmark” prescription drug premiums.
Benchmark plans have premiums at or below a cut-off in each region, which is set yearly by the Centers for Medicare and Medicaid Services (CMS).
LIS recipients who are enrolled in a Prescription Drug Plan (PDP) or Medicare Advantage plan with Part D premiums above the CMS cut-off must pay the difference between the benchmark premium and the premium charged by the plan.
Sometimes, PDPs lose benchmark status.
For LIS recipients who were auto-enrolled in a benchmark plan by CMS, CMS will also automatically move them to a different plan when their current PDP loses benchmark status the following year.
However, LIS recipients who pick a plan at any point in their Medicare eligibility (called “choosers”) are not moved automatically if their plan’s costs are above the benchmark in any subsequent year. If these LIS recipients do not affirmatively choose a new benchmark plan, they will have to pay the difference between the benchmark premium and the premium charged by their current PDP.
"Choosers receive a notice in early November on tan paper (the “tan notice”) informing them of their new premium and offering them a list of plans available with no premium liability. The tan notice goes to any chooser who will pay a premium for the first time or whose premium will go up. Choosers do not receive the tan notice if they already are paying a premium and that premium stays the same or goes down.
"•" ARE YOU PAYING A PREMIUM? If you are not sure, review your options with a State Health Insurance Assistance Program (SHIP) counselor.
You can also get help through 1-800-Medicare or on the Medicare.gov website.
The best time to review coverage options is during the Open Enrollment Period from October 15 through December 7.
Excerpts from the alert (available for download below):
"You May be Overpaying for Part D Prescription Drug Coverage"
"Every year hundreds of thousands of Medicare enrollees with the Low-Income Subsidy (LIS or “Extra" "Help”) overpay for Medicare prescription drug coverage. In 2021, for example, thirteen percent (800,000) of" "LIS enrollees were expected to pay an average of $27/month for Part D premiums in plan year 2022 if they did not switch to a premium free plan.
In many cases, the reason these individuals are paying premiums is inertia.
People who qualify for the full Medicare Part D LIS do not pay premiums if they enroll in plans with “benchmark” prescription drug premiums.
Benchmark plans have premiums at or below a cut-off in each region, which is set yearly by the Centers for Medicare and Medicaid Services (CMS).
LIS recipients who are enrolled in a Prescription Drug Plan (PDP) or Medicare Advantage plan with Part D premiums above the CMS cut-off must pay the difference between the benchmark premium and the premium charged by the plan.
Sometimes, PDPs lose benchmark status.
For LIS recipients who were auto-enrolled in a benchmark plan by CMS, CMS will also automatically move them to a different plan when their current PDP loses benchmark status the following year.
However, LIS recipients who pick a plan at any point in their Medicare eligibility (called “choosers”) are not moved automatically if their plan’s costs are above the benchmark in any subsequent year. If these LIS recipients do not affirmatively choose a new benchmark plan, they will have to pay the difference between the benchmark premium and the premium charged by their current PDP.
"Choosers receive a notice in early November on tan paper (the “tan notice”) informing them of their new premium and offering them a list of plans available with no premium liability. The tan notice goes to any chooser who will pay a premium for the first time or whose premium will go up. Choosers do not receive the tan notice if they already are paying a premium and that premium stays the same or goes down.
"•" ARE YOU PAYING A PREMIUM? If you are not sure, review your options with a State Health Insurance Assistance Program (SHIP) counselor.
You can also get help through 1-800-Medicare or on the Medicare.gov website.
The best time to review coverage options is during the Open Enrollment Period from October 15 through December 7.
| overpaying-for-part-d-medicare-practice-tip.pdf |
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