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Reminder about September Medicare mailings from CMS and the Social Security Administration affecting your 2021 Extra Help benefits

Category: Medicaid, LIS, & Extra Help
Published on 2020-08-03 10:55:17

The 2020 / 2021 mailings schedule from the Centers for Medicare and Medicaid Service (CMS), the Social Security Administration (SSA), and Medicare plans is online and includes the different form-letters sent to Medicare Part D Extra Help recipients and people qualifying for the Medicare Part D Low-Income Subsidy (LIS) program.

We have updated the list with a few links to our Frequently Asked Questions (FAQs) and News Articles:

Important: You may need to act to keep your benefits.

As a reminder, if you are a Medicare Part D beneficiary receiving financial "Extra Help" with your Medicare prescription drug plan, you may need to act soon in order to continue receiving your Medicare Part D financial Extra Help benefits through 2021.

Starting in early-September, the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) will be sending out letters to some Medicare beneficiaries regarding the status of their Medicare Part D Extra Help benefits.

If you are a Medicare beneficiary who receives one of these letters and does not respond to this September mailing, you risk losing your Extra Help benefits for 2021.  If you qualify for the 2020 Extra Help program, there are two possible letters you could receive in the mail that could affect whether you receive Extra Help in 2021:

(1) Letter from the Centers for Medicare and Medicaid Services (or CMS): You No Longer Automatically Qualifying for Extra Help!

Some people receive Medicare Part D Extra Help automatically because they qualify for Medicaid - or belong to a Medicare Savings Program - or receive Supplemental Security Income (SSI). However, if a person no longer automatically qualifies for Extra Help in 2021 (because of a change in their financial or SSI status), CMS will send a gray-colored “Loss of Deemed Status” letter before the end of September notifying the Medicare beneficiary that they may need to reapply for their 2021 Extra Help benefits.

Again, look for a gray-colored Notice that states across the top: Loss of Deemed Status Notice (Product No. 11198) and you will see the text "You no longer automatically qualify for Extra Help" and then the following text:
You must apply to see if you still qualify
You may still be able to get Extra Help in 2021, but you need to apply. Please complete the enclosed application and mail it back in the postage-paid envelope. You can also apply online at socialsecurity.gov.  To apply by phone, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also call your State Health Insurance Assistance Program (SHIP) at <your SHIP phone number will be here> for help.
Don’t delay. Apply as soon as possible to make sure that, if you qualify, you’ll continue to get Extra Help as of January 1, 2021.
To help people keep their Extra Help benefits, CMS will also include an application for Extra Help along with their grey-colored letter and encourage Medicare beneficiaries to complete the application for the 2021 Extra Help program based on their income and resource limits.

Unfortunately, if these Medicare beneficiaries do not proactively complete the application and reapply for Extra Help, they may lose their Extra Help benefits in 2021.

(2) Letter from the Social Security Administration (or SSA): You Need to Show that You Still Qualify for Extra Help!

Each year the Social Security Administration reviews the eligibility of selected low-income Medicare beneficiaries who are receiving financial Extra Help and in early-September, will send letters to select Medicare beneficiaries who qualified for the 2020 Extra Help program and ask that the recipient completes and returns a new income and resources form to ensure that the beneficiary is still eligible for the 2021 Extra Help program.

Look for: "Social Security Notice to Review Eligibility for Extra Help" along with income and asset forms.

Unfortunately, again, if a person does not complete and return the income and resources form to the Social Security Administration within 30 days, or ask for an extension, the beneficiary could lose their Extra Help benefits for 2021.

What is Medicare Part D Extra Help?

For those new to Medicare, "Extra Help" is a federal program designed to assist low-income Medicare beneficiaries pay a portion of their Medicare prescription drug costs.  Based on your income and assets (or financial resources), the Extra Help program may pay all or part of your monthly Medicare Part D plan premiums and a significant portion of your medication costs.  We have more information online about the Extra Help drug co-payments at: 2020 Federal Poverty Level Guidelines (FPL): 2020-2021 LIS Qualifications and Benefits.

Also, if you qualify for Extra Help, you will also pay either a low or no initial deductible and will not be subject to the Coverage Gap or Donut Hole portion of their Medicare Part D plan.

As an Extra Help recipient, you will also be granted a Special Enrollment Period (SEP) (one SEP per quarter from January through September) during which you can change to another Medicare Part D prescription drug plan.

Reminder - Part 1: You may still qualify for Extra Help in 2021.

As a reminder the Medicare Part D Extra Help income and basic resource limits increased slightly this year, making it easier for some people to qualify for the Extra Help program and receive financial assistance with the purchase of their prescription drugs.  To help people learn about the Extra Help program and qualifying for Extra Help, we have added more information online about the recently updated income and resource limit changes that can be found at:
Medicaid and Medicare Part D Prescription Drug Plan Costs

Reminder - Part 2: Be prepared to see how your Medicare Part D or Medicare Advantage plan is changing in 2021.

All Medicare Part D beneficiaries are reminded that their Medicare Part D prescription drug plan or Medicare Advantage plan can change monthly premiums, co-payments, and specific drug coverage each year. Therefore, all Medicare Part D beneficiaries should be prepared to review their 2021 Medicare Part D plan options and, if necessary, change their plan during the 2021 annual Open Enrollment Period (AEP) that begins on October 15 and continues through December 7.

For more information about the Extra Help or if you want to apply, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Review your Medicare Part D plan option using https://PDP-Finder.com and https://MA-Finder.com.

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.