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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |124 Effective Month: September 2018 are not covered by Medicare, but CMS requires Medicaid to cover the drug the same as for a Medicaid-only recipient. 2. In order for a Medicaid/Medicare recipient to have a $0 premium, $0 deductible, co-insurance and co-pay charges, the individual must enroll in a “benchmark” Part D plan. These are Medicare Part D plans that accept the LIS as payment in full for each recipient enrolled in the plan. Each calendar year the benchmark plans offered within each state are subject to change. Individuals enrolled in a benchmark plan that drops out of the LIS program are notified in writing by CMS of their reassignment to a new Medicare drug plan that accepts the LIS as payment in full unless the individual joins a benchmark plan of their own choosing by December 31st. These notices are mailed to the individual by late October and contain a listing of the LIS/benchmark plans available the following calendar year in their state of residence. 3. If an individual chooses a Part D plan that is not a benchmark plan, the plan can bill the individual a premium and impose deductibles, co-insurance and cop- pay charges. Only benchmark plans active for the current calendar year have $0 premiums, etc. 4. If an applicant is not enrolled in a Medicare Part D plan at the time of application for Medicaid, the individual will be auto enrolled by CMS in a Part D plan that accepts the LIS (a benchmark plan) at the time the Medicaid application is approved (no separate LIS application is required). If the individual wishes to enroll in a Part D plan of their choice (benchmark or non- benchmark), it is the individual’s responsibility to contact the Part D plan that they want or contact the Medicare toll free number at 1-800-MEDICARE. 5. If a Medicare recipient is enrolled in a Medicare Part D plan at the time of application for Medicaid but it is not a benchmark plan, the individual must change to a benchmark plan at the time the Medicaid application is approved to avoid Part D cost-sharing charges such as premiums, etc. 6. An individual applying for Medicare who does not have Medicaid applies for the LIS by applying for “Extra Help” that is part of the application for Medicare. Individuals with income at/below 135% FPL are sent to DOM as LIS applications that are processed to completion by DOM. If approved, Medicare cost-sharing benefits and benefits available through the LIS become available to the full or partially dual individual at the time of Medicaid approval.