| MedicareBlue Solutions |
| Has a letter explaining Medicare options been mailed to Plan J members? When?
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| Does the Asset Test for low income individuals include vehicles?
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| Does eligibility for low income individuals have to be demonstrated annually? |
| Are people currently covered under Medicaid Rx going to be covered under a Medicare Prescription Drug Plan regardless of their age?
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| Does the definition of Institutional Beneficiary include those in assisted living?
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| If individuals don't have to be enrolled in Part B, why are we saying that they need to continue to pay for their Part B coverage?
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| What is the effective date for people aging-in to Medicare? |
| What if someone wants to postpone paying the Part D premium for a June 1, 2006, effective date?
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| What should individuals who have drug coverage from TRICARE, the Department of Veteran's Affairs (VA), or the Federal Employee Health Benefits Program (FEHB) know about Part D?
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| Is Veterans Administration (VA) prescription drug coverage considered creditable for Part D?
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| If someone chooses to stay on Plan J with drugs, can they still in enroll in Part D?
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| Do nursing home residents fall into any other special category?
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| If a person with Medicare is off of a group plan that includes prescription drug coverage, will they receive a letter of creditable coverage to waive the late enrollment penalty?
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| Does the Iowa Portability Act override any CMS rules pertaining to someone moving outside of our service area?
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| What determines the state of residence for an individual?
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| Do all formularies need to have a drug in each therapeutic class? Does CMS require this or is it up to the carrier? |
| Do pharmacists have immediate access to the drug formulary?
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| How are compound drugs covered under the formulary? Which level?
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| How can pharmacists become part of the network?
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| Is third-party billing an option for Part D (ex: applicant's son wants to get the invoice)? Can an employer pay for it?
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| Is there a disclosure on the Electronic Enrollment Form that says, "Coverage not effective until first of month following receipt?"
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| Do agencies need to keep a copy of the enrollment application? |
| Will there be a form that needs to be filled out to waive "Part D"?
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| Will we be offering list bills for employers? |
| Can the applicant designate which day of days 1-5 they want the Part D monthly EFT withdrawal to come out of their account?
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| Will agents receive any notification letters or type of communication from vendors to let them know the status of the enrollment forms they submitted?
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| If someone wants to switch back to a Medicare Supplement Plan mid-year, can they dis-enroll from a Medicare plan?
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| If an individual wants to change the plan they initially elected prior to May 15, 2006, what is the process?
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| Is a Notice of Replacement Form required if individuals are replacing a Medicare Supplement policy with MedicareBlue PPO? |
| Are injectibles covered under MedicareBlue Rx?
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| Can individuals use money out of an HSA account to pay for the premium?
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| Do you know if the pharmaceutical assistance programs that were offered through drug companies are being discontinued, such as Merck and Pfizer?
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| Can individuals pay their premiums by EFT from a savings account or does it have to be a checking account?
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| Is there a maximum on the amount of premium increases that the Part D plans can incur each year?
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| Will members receive an ID card for the MedicareBlue Values Program?
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| What do I put for my agent and agency number on the application?
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| If an individual who is under 65 and on Medicare doesn’t elect to take part D, will they face a penalty at age 65 if they choose to take it then? |
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| MedicareBlue Solutions |
| Question: Has a letter explaining Medicare options been mailed to Plan J members? When?
Answer:
Yes. Please refer to the Blue Briefings Online article published on October 14, 2005. You can find the archived article by going to Wellmark.com. Then, click on the Broker tab and select Broker News from the left navigation bar. From there, you can search the Individual segment archived articles. |
| Question: Does the Asset Test for low income individuals include vehicles?
Answer:
No, a vehicle is a non-liquid asset and specifically excluded. More information can be found on the CMS Web site at the bottom of page 12 of the CMS Guidance to States on the Low-Income Subsidy Guide. You can insert the following address into your Internet browser to get to the guide: http://www.cms.hhs.gov/medicarereform/guidance5-25-05.pdf. |
| Question: Does eligibility for low income individuals have to be demonstrated annually?
Answer:
Yes, eligibility is good for only one year at a time. |
| Question: Are people currently covered under Medicaid Rx going to be covered under a Medicare Prescription Drug Plan regardless of their age?
Answer:
Yes. All Medicaid Rx members with Medicare coverage will automatically move to a Medicare Prescription Drug Plan. This applies to full-benefit dual eligibles only. |
| Question: Does the definition of Institutional Beneficiary include those in assisted living?
Answer:
No it does not. Institutional refers to a health status that is attributed to a beneficiary who is a resident in an institution or distinct part of an institution that has been certified by Medicare or Medicaid. This health status can only be assigned after they have been a resident of a certified institution for a qualifying period. |
| Question: If individuals don't have to be enrolled in Part B, why are we saying that they need to continue to pay for their Part B coverage?
Answer:
A beneficiary does not need to be enrolled in Part B to enroll in Part D. They only need to pay their Part B premium if they are enrolled in Part B. |
| Question: What is the effective date for people aging-in to Medicare?
Answer:
Individuals who become eligible for Medicare on or after February 1, 2006, will have an initial enrollment period for Part D that is the seven-month period surrounding Medicare eligibility; beginning three months before the month an individual meets the eligibility requirements for Part B and ends three months after the month of eligibility. |
| Question: What if someone wants to postpone paying the Part D premium for a June 1, 2006, effective date?
Answer:
They need to make their choice no later than May 15, 2006, to avoid penalties. |
| Question: What should individuals who have drug coverage from TRICARE, the Department of Veteran's Affairs (VA), or the Federal Employee Health Benefits Program (FEHB) know about Part D?
Answer:
As long as they still qualify, their TRICARE, VA, or FEHB prescription drug coverage is not changing. They should contact their benefits administrator or FEHB coverage before making any changes. |
| Question: Is Veterans Administration (VA) prescription drug coverage considered creditable for Part D?
Answer:
Yes, VA prescription drug coverage is considered creditable coverage. |
| Question: If someone chooses to stay on Plan J with drugs, can they still in enroll in Part D?
Answer:
They cannot enroll in Part D if they are keeping Plan J with drug benefits. |
| Question: Do nursing home residents fall into any other special category?
Answer:
They could fall into a special category that would be based on their personal income level and if they are Medicaid eligible (i.e., low-income or dual eligible). |
| Question: If a person with Medicare is off of a group plan that includes prescription drug coverage, will they receive a letter of creditable coverage to waive the late enrollment penalty?
Answer:
They should receive a letter of creditable coverage from the group plan. Group plans are required to provide a statement of creditable coverage annually and upon request of the member. |
| Question: Does the Iowa Portability Act override any CMS rules pertaining to someone moving outside of our service area?
Answer:
No. To enroll in MedicareBlueSM Rx or MedicareBlueSM PPO, you must be a resident of Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, or Wyoming. MedicareBlueSM Solutions |
| Question: What determines the state of residence for an individual?
Answer:
The information that the Social Security Administration has on file and the address to which their Social Security checks are mailed determines the state of residence. |
| Question: Do all formularies need to have a drug in each therapeutic class? Does CMS require this or is it up to the carrier?
Answer:
Yes, all formularies do need to have a drug in each therapeutic class, but it's not necessary to include all of the drugs. This is required by CMS. |
| Question: Do pharmacists have immediate access to the drug formulary?
Answer:
The drug formulary is available 24-hours a day on YourMedicareSolutions.com. |
| Question: How are compound drugs covered under the formulary? Which level?
Answer:
If the component parts of the compound are FDA-approved prescription drugs, then the compound is generally covered under Part D. |
| Question: How can pharmacists become part of the network?
Answer:
A pharmacy that's interested in joining the network should contact Prime Therapeutics at (800) 821-4795. |
| Question: Is third-party billing an option for Part D (ex: applicant's son wants to get the invoice)? Can an employer pay for it?
Answer:
Yes, the mailing address for the monthly statement can be different. An employer cannot pay for an individual plan, only for a group filed PDP. |
| Question: Is there a disclosure on the Electronic Enrollment Form that says, "Coverage not effective until first of month following receipt?"
Answer:
The Electronic Enrollment Form will exactly mirror the paper enrollment form. The paper Enrollment form was modeled from CMS requirements, and it does not contain language referencing the effective date. This should be explained to the individual by the agent. |
| Question: Do agencies need to keep a copy of the enrollment application?
Answer:
Agencies are not required to keep a copy of the enrollment application; however, they may want to keep a copy for their records. |
| Question: Will there be a form that needs to be filled out to waive "Part D"?
Answer:
At this time there is not a Part D waiver form. |
| Question: Will we be offering list bills for employers?
Answer:
No. This is not an option at this time. |
| Question: Can the applicant designate which day of days 1-5 they want the Part D monthly EFT withdrawal to come out of their account?
Answer:
No. The draft will always be on the 5th of the month. |
| Question: Will agents receive any notification letters or type of communication from vendors to let them know the status of the enrollment forms they submitted?
Answer:
No. Agents will not receive any type of notifications from our vendors. Wellmark will send a report to our agencies that shows who has enrolled in MedicareBlue Rx and MedicareBlue PPO. |
| Question: If someone wants to switch back to a Medicare Supplement Plan mid-year, can they dis-enroll from a Medicare plan?
Answer:
Individuals are allowed to make changes during the annual enrollment period as determined by CMS or during a special election period, otherwise they are subject to the lock-in rule. In 2006, an individual eligible for Medicare may make one Medicare Advantage change during the open election period from January 1 through June 30. There are other specific rules; such as, an individual may make an election during an annual election period, special election period, and initial enrollment. They are all described on page 26 of the CMS Manual (Publication 100-16 Medicare Managed Care). You can insert the following address into your Internet browser to get to the online manual (found on www.cms.gov): cms.hhs.gov\manuals\pm_trans\r66mcm.pdf. |
| Question: If an individual wants to change the plan they initially elected prior to May 15, 2006, what is the process?
Answer:
There is a Short Enrollment (change) form they would submit. |
| Question: Is a Notice of Replacement Form required if individuals are replacing a Medicare Supplement policy with MedicareBlue PPO?
Answer:
No. All information needed is contained on the MedicareBlue PPO enrollment form. |
| Question: Are injectibles covered under MedicareBlue Rx?
Answer:
Injectibles previously covered under Part B will continue to be covered under Part B. Other injectibles may be covered under MedicareBlue Rx. Check the formulary for specific information. |
| Question: Can individuals use money out of an HSA account to pay for the premium?
Answer:
Yes. Deductible health insurance premiums (other than for a Medicare Supplemental policy) for an account holder who is age 65 or older can be paid or reimbursed through an HSA on a tax-free basis, including medical premiums for an employer's insured or selfinsured retiree health coverage. |
| Question: Do you know if the pharmaceutical assistance programs that were offered through drug companies are being discontinued, such as Merck and Pfizer?
Answer:
Pharmaceutical companies are not required to discontinue their assistance programs. It is up to each company to decide whether or not they want to offer it. |
| Question: Can individuals pay their premiums by EFT from a savings account or does it have to be a checking account?
Answer:
Yes. Monthly premiums may be deducted from a checking or savings account. |
| Question: Is there a maximum on the amount of premium increases that the Part D plans can incur each year?
Answer:
No. Premiums are determined via an annual bid process that is completed each June. There are no limits, but all increases have to be approved by CMS and supported by financial results. |
| Question: Will members receive an ID card for the MedicareBlue Values Program?
Answer:
No. They simply show their MedicareBlue Rx or MedicareBlue PPO ID card. |
| Question: What do I put for my agent and agency number on the application?
Answer:
You need to put your full 66300*** agent number in the agent field and then 663 as the agency number. |
| Question: If an individual who is under 65 and on Medicare doesn’t elect to take part D, will they face a penalty at age 65 if they choose to take it then?
Answer:
Yes, unless they’re covered under an employer plan that is creditable. This would be rare, though. |
