SSA Medicare D

State MMA Program Orientation: 

State MMA Program Orientation Medicare Prescription Drug Program BACKGROUND

Medicare: 

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 Gehrig’s Disease (Amyotrophic Lateral Sclerosis - ALS)

The Parts of Medicare: 

The Parts of Medicare Hospital Insurance (Part A) Supplementary Medical Insurance (Part B) Medicare Advantage Prescription Drug Program

Medicare and Medicaid: 

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

Medicare vs. Medicaid: 

Medicare vs. Medicaid Medicaid: Administered by Federal Government and State Differs from State to State Eligibility related to financial need

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

Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Drug Discount Card 5/3/04—5/15/06 (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

Roles and Responsibilities: 

Roles and Responsibilities Social Security Administration Centers for Medicare & Medicaid Services (CMS) States

Roles and Responsibilities: 

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

Roles and Responsibilities: 

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

Roles and Responsibilities: 

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

Social Security Administration: 

Social Security Administration Application for Help with Medicare Prescription Drug Plan Costs

History of the Application : 

History of the Application Focus Groups Advocacy Meetings Congressional Briefings Cognitive Testing Engineer Evaluation State Medicaid Directors

Deemed Population: 

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

Not Deemed Population: 

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

Resources: 

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

Resources: 

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

Family Size: 

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

Income: 

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

Income: 

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

Income: 

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

Submitting the Application: 

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

Appeals: 

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

Eligibility-Changing Events: 

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

Redeterminations: 

Redeterminations Re-evaluation of person’s income, family size and resources to determine continuing eligibility for help with drug plan costs

For More Information: 

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