01/19/2007
Enrollment changes for Medicare passed for 2007
This article is no longer applicable. Please refer to CMS provides clarification to Limited Open Enrollment Period article.
The Tax Relief and Health Care Act of 2006 has been passed into law and signed by President Bush. For the first time, the new law allows certain Medicare beneficiaries to be enrolled in both a Prescription Drug Plan (PDP) and a separate Medicare Advantage (MA)-only plan at the same time.
It also provides for limited continuous MA open enrollment periods for select eligible beneficiaries in 2007 and 2008. The new continuous enrollment provision is limited to MA-only enrollment, and does not create a new open enrollment opportunity to join a PDP or MA-PD (Medicare Advantage plan with prescription drugs).
Here’s what you need to know about the new law:
- Medicare beneficiaries with Medicare Fee-for-Service (FFS)--such as Medicare Parts A and B only--or a Cost plan, or those with a Medigap plan will be able to join a Medicare Advantage plan (without prescription drug coverage) anytime throughout 2007 and 2008.
Note: A Private Fee-for-Service plan (PFFS) is different from Medicare Fee-for-Service (FFS). Medicare FFS is Parts A and B only, a Medigap plan or a Cost plan.
- These beneficiaries can join Asuris’ MedAdvantage + Rx or MedAdvantage + Rx Enhanced only during the open enrollment period (Jan. 1 - March 31) if they already have a plan with Part D or a Part D stand-alone plan (PDP).
- After March 31, they can join a Medicare Advantage-only plan without prescription drug coverage and keep their current PDP if they have one.
- If a Medicare beneficiary is already in a PFFS Medicare Advantage plan, then that beneficiary would not qualify for the continuous open enrollment. The beneficiary must be on a Medicare FFS plan to move to a Medicare Advantage plan after the open enrollment period.
The Centers for Medicare & Medicaid Services (CMS) say that it will take 60 to 90 days to implement the new law.
Right now we are currently in the Open Enrollment Period (OEP) Jan. 1- March 31, 2007. Here’s a grid that shows what Medicare beneficiaries can do during OEP.
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If current coverage is
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Can use OEP to get
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Cannot use OEP to get
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Medicare Advantage with prescription
drug coverage (MA-PD)
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MA-PD or Original Medicare + PDP
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MA-only or Original Medicare only
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Medicare Advantage with
no prescription drug coverage (MA-only)
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MA-only or Original Medicare only
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MA-PD orOriginal +PDP
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Original Medicare and
a prescription drug plan (PDP)
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MA-PD
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MA-only or A different PDP to use with Original Medicare
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Original Medicare only
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MA-only
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MAPD or Original Medicare +PDP
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Applications that come into Asuris Northwest Health will be processed according to existing OEP rules listed in the chart above. The new law and rules will not be implemented until we hear from CMS.
Please let your members know that Asuris Northwest Health will implement the new law as soon directed by CMS.
For more information regarding the Special Enrollment Periods (SEP) effective for 2007 visit the CMS website.
If you have questions about Medicare Advantage and Part D plans, please talk with your Asuris Sales contact.
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