Serving children and adults with intellectual and developmental disabilities

Medicare Part D Issues - Horizon Medicare Rx Plan 2

There are a few important Medicare Part D issues for you to be aware of prior to January 1, 2007.  All of the following information pertains to Horizon Medicare Rx Plan 2. 


1. Background Information:

As you know, prior to the beginning of Medicare Part D on Jan. 1, 2006, the dual eligibles (persons who receive both Medicaid and Medicare) were auto-assigned by the Centers for Medicare and Medicaid Services (CMS) to a prescription drug plan (PDP). CMS permitted the dual eligibles to enroll in a drug plan that was different from the one to which they were auto-assigned. However, beginning January 1, 2007, there will be an increase in the monthly premium of Horizon Medicare Rx Plan 2. Because the new monthly premium amount for Horizon's Plan 2 is $35.70, which is higher than the CMS benchmark , CMS will not cover this fee for the dual eligibles in 2007. The CMS low-income premium benchmark for New Jersey is $28.12.


2. CMS is treating the dual eligibles who were auto-assigned into Horizon Medicare Rx Plan 2 differently from those dual eligibles who selected this drug plan:

·      Auto-assigned dual eligibles: The dual eligibles who were auto-assigned to Horizon Medicare Plan 2 should receive a letter from CMS informing them that they will be automatically switched into Horizon Medicare Rx Plan 1, effective Jan. 1, 2007. We are hoping that these dual eligibles will have a smooth, automatic transition, without any difficulties. 

·      Non-auto-assigned dual eligibles:  The dual eligibles who were auto-assigned to another drug plan, but decided to choose Horizon Medicare Rx Plan 2 instead, will not receive any notification from CMS informing them that they need to switch to another drug plan in order to avoid paying a premium fee every month.  Therefore, we are suggesting these dual eligibles switch to either Horizon Medicare Rx Plan 1, or they can switch to another benchmark drug plan. This switch needs to take place as soon as possible, but no later than the first two weeks in December. (Please note: The amount the dual eligibles will be charged if they remain in the Horizon Plan 2 is $7.58 per month, which is the difference between the $35.70 regular premium and the $28.12 low-income premium benchmark.)   Dual eligibles do not need to wait until Nov. 15th (the start of the "open enrollment" period) to switch to another drug plan because they are permitted to switch drug plans at any time.


3. Please read the Annual Notice of Change (ANOC) from the Medicare Part D plan, which should arrive by October 31, 2006:

All Part D plans are required by CMS to send their enrollees an Annual Notice of Change (ANOC).  Included in the ANOC will be important information on the new formulary (the list of drugs that the plan will cover for 2007), pharmacy network changes, cost changes, and a summary of benefits. 
 

 The Arc of New Jersey is pleased to announce…

Important Seminars for Staff and Families:

The Impact of New Changes in the Medicare Drug Benefit on Dual Eligibles with Developmental Disabilities

Beginning on January 1, 2008 there will be significant changes in Medicare Part D, the federal drug benefit that is used by all dual eligibles (persons who have both Medicaid and Medicare) to obtain their prescription medications.

These seminars are for employees of DD provider agencies, DDD case managers, family members, and health care professionals who care for dually eligible consumers.

 There is no charge, but pre-registration is required.

Directions are available upon request.

THE SEMINARS WILL BE OFFERED AT THESE LOCATIONS:

Thursday, November 29th, 10:00 a.m. – 12:00 noon (Morris County)
The Arc/Morris County – St. Elizabeth's Center
2 Convent Road – Duffy Building
Convent Station, NJ 07961

Monday, December 3rd, 10:00 a.m. – 12:00 noon (Burlington County)
Rutgers Cooperative Extension of Burlington County
2 Academy Drive
Westampton, NJ 08060

Monday, December 10th, 10:00 a.m. – 12:00 noon (Monmouth County)
The Arc of Monmouth County
1158 Wayside Road
Tinton Falls, NJ 07712

Friday, December 14th, 9:30 a.m. – 11:30 a.m. (Essex County)
Livingston Senior and Community Center
204 Hillside Avenue
Livingston, NJ 07039

To register, please contact Diane Flynn at The Arc of New Jersey:
Email: dflynn@arcnj.org  Phone: 732-246-2525, ext. 28
Please provide:
   Name and phone number
   Number of persons attending
   Date and location of the training you wish to attend.

Click here to see a printable flyer.