Medicare Part D

njjel

Can anyone enlighten me on the requirements of Medicare Part D for employers?

ritaanz

Part D is prescription drug coverage for those eligible for Medicare. Medicare recipients need to do their homework.

If they are in a plan that provides drug coverage, they need to find out if it will continue in 2006. In October, private companies will be releasing details of their individual plans. They will want to copmpare their present plan to the coverage available in Part D.

Part D goes into effect January 1, 2006. Between now and then you will be deluged with information. Your medical insurance carrier should be providing you with the details concerning Part D.

njjel

That is my understanding also other than I understood the employer is obligated to send out a notice to the employees and I'm unclear on that.

JM in ATL

There are two notices that need to be sent out. The first one to be sent to all post age 65 terirees and disabled persons. It is due by August 15th. The letter pretty much needs to state the retirees rights to Medicare Part D

The second letter is due by October 1st and it is a letter of credible coverage. This one should state that if they do not enroll within the time frame that medicare has set to enroll withing the part D, they will need a letter stating that they had previously had credible coverage therefore did not enroll when they had the opportunity.

Post 65 retirees and disabled persons DO NOT have to enroll in this coverage if they have credible coverage elsewhere. It is just an added benefit that they can but at this time.

There is a $250 dedcutible annual. Medicare will reimburse up to 75% up to the first 2K on drugs then they do not reimburse anything after that, UNLESS the out of pocket drug costs exceed 5100K. Any thing that they spend out of pocket above and beyond that will be reibursed at 95%.

I believe the monthly premium for the Part D is $37 per month.

The enrollment period is Nov. 15, 05 - May 15, 06. This is for those who currently qualify for Medicare. If qualified people don't enroll by the deadline, they will be subject to a higher monthly premium unless they can show proof of credible coverage - thus the letter due in October.

Hope this helps...

ritaanz

I have not heard that. Our medical carrier has developed a guide called Introduction to Part D. It is my understanding that they will be sending this to all of their customers.

LivindonSouth

Maybe if I was old enough I would know something about this.




Disclaimer: This message is not intended to offend or attack. It is posted as personal opinion. If you find yourself offended or uncomfortable, email me and let me know why.

JM in ATL

One other note: Here is the contact info for Medicare should you want to do additional research

1-800-633-4227

[url]www.medicare.gov[/url]

njjel

Thank you for this information. Does anyone have a sample of the letter(s) the employer is to send to all employees? I say all because we do not know the age of spouses. At least we don't know them here.

njjel

I myself became aware of this regulation when I received a notice from a law firm we used to deal with advising us it was upcoming! It sounds very complicated.

Gloria

[url]http://www.cms.hhs.gov/medicarereform/CCNoticeCMS-NAICapprvd.pdf[/url]

[url]http://www.cms.hhs.gov/medicarereform/Non-CredCov-BeneDsclsreNtc.pdf[/url]

[url]http://www.cms.hhs.gov/medicarereform/CCGuidance.pdf[/url]

[url]http://www.unitedhealthgroup.com/about/MedicarePartDShowMeGuide.pdf[/url]


Here is some information from CMS and United Health Group. Hope this will help a little

Thanks.

G

njjel

thank you for the info.

LivindonSouth

why is this the employer's obligation?




Disclaimer: This message is not intended to offend or attack. It is posted as personal opinion. If you find yourself offended or uncomfortable, email me and let me know why.

njjel

Because Congress said so. If you go to the links above and read the material, you will become enlightened. :-)

DB

I can't find anything (other than this site) that talks about a notice due by August 15. Our plan, UHC, has sent me a lot of information but nothing with that date.

Does anyone else know about the August 15 notice?

mushroomHR

Do these notices have to go out to current employees who are 65 or over or just to retirees covered by the healthplan? Also, how are we supposed to know if an employee and spouse are "entitled" to Medicare Part A? (This means that they actually have Part A coverage, not just when the person is first eligible.) I have no clue whether or not an employee has applied for and is currently receiving Part A. It all sounds quite confusing to me.

irenesmsaclaims

[font size="1" color="#FF0000"]LAST EDITED ON 08-12-05 AT 06:45PM (CST)[/font][br][br]I don't think it's an August 15 deadline either. My understanding is that Medicare participants have to enroll after November 15 for the Part D prescription coverage to be effective January 2006.

The employer must send notifications to Medicare participants (retired, active over 65, dependent spouses or disableds) who are on the plan before November 15, 2005. This notice states whether the plan is creditable or non-creditable.

I think that it may be easier to send it to everyone on the plan if you can't easily determine who may be on Medicare, for the various reasons they can be. The notice can be within the SPD or an outside notice.

Plans must determine if they are creditable or non-creditable, and this can require an actuarial calculation. Yes, I think it is complicated, but employers can receive a subsidy for drug benefits if all is done right.

njjel

I have obtained more info from the SHRM site on this:

September 30 is the deadline for employers to apply for a federal subsidy for providing a prescription drug benefit to retirees and other Medicare beneficiaries.

November 15th is the first day Medicare-eligible beneficiaries cansign up for a Medicare prescription drug plan; it is also the date by which employers must inform beneficiaries whether their employer-provided coverage meets the standards of a Medicare-qualified prescription drug plan.

Hope this helps.