Medicare Part D
Hunter1
808 Posts
[font size="1" color="#FF0000"]LAST EDITED ON 08-05-05 AT 11:54AM (CST)[/font][br][br]I'm just coming up to speed on this, so can someone help out?
Our health plan, which includes prescription drug coverage, does not include a mail order option. We only cover employees over the age of 65 if they continue to work. Sometimes, in addition, we will have a spouse on our plan who is older than 65 while the employee is still working.
First, it seems that we are going to have to notify Medicare eligible individuals of their coverage/options, etc, right? And, because our plan doesn't have a mail order option, will it not be 'creditable' coverage, even though our benefit plan is much richer than the Medicare plan?
Edit: To clarify: It seems that the ONLY part of the simplified creditable coverage test that our plan wouldn't meet if we do not apply for the subsidy is the optional mail-order requirement. (We have so few Medicare-eligible insureds that it wouldn't be cost effective for us to have the necessary actuarial study required for the subsidy.)
Our health plan, which includes prescription drug coverage, does not include a mail order option. We only cover employees over the age of 65 if they continue to work. Sometimes, in addition, we will have a spouse on our plan who is older than 65 while the employee is still working.
First, it seems that we are going to have to notify Medicare eligible individuals of their coverage/options, etc, right? And, because our plan doesn't have a mail order option, will it not be 'creditable' coverage, even though our benefit plan is much richer than the Medicare plan?
Edit: To clarify: It seems that the ONLY part of the simplified creditable coverage test that our plan wouldn't meet if we do not apply for the subsidy is the optional mail-order requirement. (We have so few Medicare-eligible insureds that it wouldn't be cost effective for us to have the necessary actuarial study required for the subsidy.)
Comments
I read an article yesterday naming 2 or 3 major retail chains who had announced plans to add information kiosks within the next week near their Rx counters in an effort to begin to educate Medicare-eligible patrons. The article also described that that form of information dissemination at such a preliminary date by the retailers would be noncompliant in that it could be not begin until 10/15. The CMS web page makes several references to a huge marketing blitz to be initiated at that level to ensure Medicare-eligible consumers have appropriate information to make the correct decisions for themselves. Apparently, Medicare penalties for delayed enrollments in the benefits are expected to be sizable (as with other late Medicare enrollments), and a general fear may be who would assume responsibility for misinforming the public, especially if the misinformation caused someone to incur a penalty down the road.
I do know (or at least I've read) that the penalty for individuals who do not sign up at the time they are eligible is 1% of the premium for each month they don't sign up. In other words, if the employer informed them that they had creditable coverage so the employee didn't sign up until, say 4 years later when they lost coverage through the employer's plan, and it turned out that the coverage they had wasn't creditable, the individual would pay a 48% (48 months) higher premium than if they had signed up when they were eligible.
Please post more info as you learn more. This issue will affect most all of us.
Thanks,
==>Creditable Cover Guidance,
==>Model notice informing Medicare participants of creditable coverage and a
==>Model notice informing the Medicare participants of non-creditable prescription coverage.
[url]http://www.cms.hhs.gov/medicarereform/CCGuidance.pdf[/url]
[url]http://www.cms.hhs.gov/medicarereform/CredCov-BeneDsclsreNtc.pdf[/url]
[url]http://www.cms.hhs.gov/medicarereform/Non-CredCov-BeneDsclsreNtc.pdf[/url]
Pages 1, 2, 3 & 10 of the Creditable Cover Guidance also have additional links for publications, FAQs, etc.
Hope this will be helpful
G
Thanks,
I do know there is some sort of major educational/marketing blitz planned through CMS, so we'll probably all know in the near future. My understanding to date, however, is that the message must be confirmed to any Medicare-eligible participant. Based on that understanding, my next-level question to our reps has been whether that includes dependents who are also Medicare-eligible. So far, our reps have declined to answer that question as well.
Maybe another forumite has more insight.
Another question I have is does anyone know where to find the information for the employer's 28% subsidy program and how to apply for it through CMS?