State MMA Program Orientation

1
State MMA Program Orientation
Medicare Prescription Drug Program BACKGROUND
2
Medicare

• Medicare provides health insurance for
• Individuals 65 and older
• Disabled individuals entitled to
• Social Security benefits
• for 24 months
• People who have
• permanent kidney failure
• (ESRD)
• People who have Lou Gehrigs Disease (Amyotrophic
  Lateral Sclerosis - ALS)

3
The Parts of Medicare

• Hospital Insurance (Part A)
• Supplementary Medical Insurance
• (Part B)
• Medicare Advantage
• Prescription Drug Program

4
Medicare and Medicaid

• Medicare
• Administered by Federal Government
• Same benefits throughout U.S.
• Eligibility not related to financial need

5
Medicare vs. Medicaid

• Medicaid
• Administered by Federal Government and State
• Differs from State to State
• Eligibility related to financial need

6
Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA)

• Drug Discount Card
• 5/3/045/15/06
• (or earlier, if enrolled in a
• Medicare prescription drug plan)
• Medicare Prescription Drug
• Program
• Effective 1/1/06
• Help with Drug Plan Costs
• Assistance with premiums, annual deductible,
  co-payments for beneficiaries with limited
  resources/incomes
• Effective 1/1/2006

7
Roles and Responsibilities

• Social Security Administration
• Centers for Medicare Medicaid Services (CMS)
• States

8
Roles and Responsibilities

• Centers for Medicare Medicaid Services (CMS)
• Overall Medicare Prescription Drug Program
• Notify deemed population (automatically
  eligible for help with drug plan costs)
• Enroll certain beneficiaries in Medicare-approved
  prescription drug plans

9
Roles and Responsibilities

• States
• Identify deemed population to CMS
• Work with Social Security to establish
  eligibility of not deemed
• Use Application for Help or
• Set up state equivalent process
• Train state employees

10
Roles and Responsibilities

• Social Security Administration
• Develop application for not deemed
• Develop and operate process for establishing
  eligibility
• Train employees
• Develop materials and programs for, and conduct,
  national outreach

11
Social Security Administration

• Application for Help with Medicare Prescription
  Drug Plan Costs

12
History of the Application

• Focus Groups
• Advocacy Meetings
• Congressional Briefings
• Cognitive Testing
• Engineer Evaluation
• State Medicaid Directors

13
Deemed Population

• People who are automatically eligible for help
  with drug plan costs
• Do not have to complete an application
• States work with CMS to process deemed population

14
Not Deemed Population

• Medicare beneficiaries who have limited resources
  and low income
• DO NOT have SSI or Medicaid or a Medicare
  Savings Program
• Must apply for the help with drug plan costs

15
Resources

• Cash and any other personal property a person
  owns
• Bank account(s)
• Stocks
• Bonds
• Retirement Accounts
• Mutual Fund Shares
• Real Property other than primary residence

16
Resources

• Not Counted
• Principal place of residence
• Non-liquid resources (family heirlooms,
  wedding/engagement rings, vehicles)
• Burial spaces and some funds for funeral/burial
  expenses

17
Family Size

• Affects the income used to determine eligibility
• Use Federal Poverty Level Guidelines
• Includes spouse and relatives who live with and
  are dependent for at least one-half support

18
Income

• Anything the individual receives in cash or in
  kind used to meet needs for food and shelter
• Earned income
• Unearned income

19
Income

• Earned Income
• Wages
• Net earnings from self-employment
• Royalties/Honoraria
• Payment for service in sheltered workshop
• In-kind earned income

20
Income

• Unearned Income Examples
• Social Security benefits
• Veterans benefits
• Pensions
• Rental income
• Dividends
• Interest

21
Submitting the Application

• File early!
• Mail Social Security Administration
• Wilkes-Barre Data Operations Center
• P.O. Box 1020
• Wilkes-Barre, PA 18767-9910
• Internet
• Will receive a receipt

22
Appeals

• Administrative review process
• Telephone hearing
• Case Review
• Issues for appeal
• Eligibility
• Full or partial
• Adjustment
• Termination
• Judicial Review/Remand

23
Eligibility-Changing Events

• Marriage
• Divorce
• Annulment
• Separation (not temporary)
• Co-habitation after separation
• Death of spouse

24
Redeterminations

• Re-evaluation of persons income, family size and
  resources to determine continuing eligibility for
  help with drug plan costs

25
For More Information

• Social Security Administration
• www.socialsecurity.gov
• 1-800-772-1213
• Centers for Medicare Medicaid Services
• www.medicare.gov
• 1-800-633-4227