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OVERVIEW OF PART D

Starting in January 2006, Medicare will cover prescription drugs. This new program is called Part D. Part D will help many people get their prescriptions. If you have Medicare Part A or B, then you can get Part D. Customers must choose a Part D drug plan. The Part D drug plans will cover many if not most drugs. However, each Part D drug plan covers different medications. Customers need to pick the right plan for their needs. Customers may pick a drug plan starting November 15, 2005. Part D is not free, but customers can get “extra help.” This extra help pays for the Part D deductible and monthly premiums. It also reduces the co-payments for each prescription. ESA determines eligibility for this extra help. The Medicare Modernization Act of 2003 requires that District and other states determine the eligibility for Part D’s low income subsidy. Customers may apply through ESA to get this extra help with Part D. The District has minimized these costs by automating this process. Specifically, the District aligned the income limit of the “Qualified Medicare Beneficiary” (QMB) program with that of the new Part D subsidy. Thus, persons eligible for the Part D low-income subsidy would also be eligible as QMBs. As required by law, the federal government then “deems” all QMB enrollees as automatically eligible for the full Part D subsidy. By merging these eligibility processes, the District eliminated the need for duplicative, stand- alone eligibility determinations for the Part D subsidies. This automated process vastly streamlines the eligibility process. District residents need to complete only one form (ESA’s new Combined Application) to apply for the Part D subsidy, the QMB program, Medicaid, Food Stamps, and cash assistance. Thus, the District’s process is both fiscally attractive and customer- friendly. Moreover, this process maximizes the number of District residents who will get the full Part D subsidy. By enrolling all eligible persons under 150 percent Federal Poverty Level (FPL) as QMBs, the District ensures that these customers will not have to pay a Part D monthly premium and will not have to pay a deductible. Further, all customers will pay the lowest possible cost-sharing amounts ($1 and $3 per prescription) under Part D. If this were not done, those customers with incomes between 135 percent and 150 percent FPL would be responsible for monthly premium payments of approximately $37 and an annual deductible of $50. Additionally, all persons above 100 percent FPL would face higher cost-sharing under Part D. The costs of this streamlined approach are nominal. To align the eligibility criteria of the QMB and new Part D subsidy programs, the District simply increased the income eligibility limit for the QMB population from 100 percent to 150 percent of the FPL. To explain these changes, the District developed a simple, one-page fact sheet. This flyer, which is available in both Spanish and English, is easy to read and understand. Customers can request this flyer from their ESA worker or by calling (202) 724-5506. Privacy Note: As with all Medical Assistance programs, ESA staff member are bound by the confidentiality provisions of 42 CFR 431 Subpart F and other District and federal statutes and regulations. These provisions are detailed in Part II, Chapter 3 of the ESA Policy Manual. To safeguard the confidentiality of customer data, it is essential to fully comply with these confidentiality procedures.