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 Why Does Medicaid Matter to People with Disabilities and their Families?

Changes in Medicare Part D for Dual Eligibles

Medicare Part D


Changes in Medicare Part D that will impact a large number of New Jersey’s dual eligibles (persons who have both Medicaid and Medicare) - beginning January 1, 2009

This notice describes three types of important letters that will be mailed to dual eligibles in the next few weeks.  The letters on blue and tan paper described below will be mailed to approximately 60,000 dual eligibles in New Jersey.  The Annual Notice of Change (ANOC) letters will be sent to all enrollees in Medicare Part D.

The letter on blue paper – for dual eligibles who are being re-assigned to a new drug plan:

In early November 2008, 51,000 New Jersey dual eligibles received a letter from the Centers for Medicare and Medicaid Services (CMS), printed on blue paper, informing them that CMS will auto-assign them to a new drug plan, unless they enroll in a different drug plan (of their own choosing) before December 31, 2008.

The letter on tan paper– for dual eligibles who chose their current drug plan, but who should switch to a different plan to avoid being charged a monthly fee:

In early November 2008, 9,000 New Jersey dual eligibles received a letter from CMS, printed on tan paper, informing them that if they remain in their current drug plan, they will have to pay a premium fee every month, starting January 1, 2009.  Therefore, those individuals are advised to switch to another drug plan.  CMS refers to this group of people as “choosers” because they are currently in a drug plan that they selected, rather than the plan to which CMS auto-assigned them.   If the “choosers” who receive the tan letter do not switch to another drug plan before January 1, 2009, they will be charged a monthly fee for every month that they remain in that plan.  The Medicaid wrap-around will not cover this expense. 

Therefore, it is extremely important for the dual eligibles who receive the tan letter, or their caregivers, to switch them to a drug plan in which there will not be a monthly fee.  We have been informed that the tan letter will provide a list of drug plans to which the dually eligible individual can switch, which are available without a monthly premium.  The list of these no-fee, “benchmark,” drug plans for dual eligibles is linked to this website, below. 

The Annual Notice of Change (ANOC)

Everyone who is enrolled in Medicare Part D should receive the Annual Notice of Change (ANOC) in the mail by October 31, 2008.   The ANOC is sent by the individual’s current Medicare drug plan.  This notice specifies the changes that will occur in that drug plan’s formulary, beginning on January 1, 2009, as well as any other important drug plan changes.  Please read this information carefully.


1) The CMSre-assignment form letter (the blue letter) and the Introduction to that letter.

2) The CMS form letter for “choosers” (the tan letter) and the Introduction to that letter.

3) A listing of all of the 2009 no fee "benchmark" drug plans for New Jersey’s dual eligibles and other individuals who receive the low income subsidy (LIS).  When dual eligibles enroll in a “benchmark” drug plan, they will not have to pay a monthly fee to the drug plan.

We will disseminate additional information regarding Medicare Part D changes for the dual eligibles as it is received.

The Medicaid wrap-around:

New Jersey ’s Legislature and Governor have allocated a limited amount of state funds to help the dual eligibles receive the medications they need, if their prescription drugs are not covered by Medicare Part D.  This financial help is called the Medicaid wrap-around, and it is available only for New Jersey’s dual eligibles.  This is what the wrap-around provides:

  1. The Medicaid wrap-around pays for a 6-day emergency supply of medication, without prior authorization, whenever a dual eligible needs a prescription drug that is not covered by the Medicare prescription drug plan (PDP).  The pharmacist should provide the 6-day supply without a delay.
  2. The Medicaid wrap-around is available when a PDP denies a provider’s request for an exception.  As soon as the dual eligible (or caregiver) is informed that the medication is not covered by the PDP, the prescriber of that medication should be contacted.  He/she may decide to prescribe another, equally effective, medication that is on the drug plan formulary.  However, if the provider decides that the medication cannot be changed, then he/she should fax a request for an exception to the drug plan.   The drug plan must respond within 72-hours.   If the Medicare drug plan rejects the request for an exception, then the Medicaid Medical Exception Process (MEP) should be initiated to determine whether the State’s wrap-around program will pay for the drug.  The MEP unit may be reached by a prescriber or a pharmacist by calling 1-877-888-2939;  the unit does not take calls from consumers.

  3. The Medicaid wrap-around also has funds to pay the required co-payments for dually eligible individuals.  The pharmacists are aware of this provision.  However, if a dual eligible encounters a problem with a particular pharmacy, the State Medicaid hotline (1-800-356-1561) should be contacted to re-educate the pharmacist.
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