Page 1130

1130 Chapter 7:Worker guides • Section 6: MSP worker guides (07/2026) including prescription drugs. MA-PDs cover Medicare Parts A, B, and D. Only people with Medicare Parts A and B may enroll in a Medicare Advantage Plan. • A Medicare Advantage-Special Needs Plan (SNP) serves particular groups (such as people with specific diseases or conditions, people in nursing facilities, or people with Medicaid). Both MA-PDs and SNPs can be coordinated care plans that offer Medicaid benefits in coordination with all the individual’s Medicare benefits. Individuals undergoing a continuing treatment of dialysis for End-Stage Renal Disease (ESRD) are not eligible for either of these plans. An individual wishing to participate in these plans should choose both the Medicaid Managed Care plan/Coordinated Care Organization (CCO) and the Medicare Advantage plan offered by that company. Very few Fully Capitated Health Plans will allow an individual to remain in the Medicaid managed care plan if the individual does not enroll in the Medicare plan offered by that company. CCOs, however, will allow individuals to enroll regardless of whether they are also enrolled in their Medicare Advantage affiliated plan. Enrolling in a Plan CMS lists the names of the plans offering the prescription drug benefit in the annual Medicare & You handbook. Plan information can also be accessed on Medicare’s website www.medicare.gov, or by calling 1-800-633-4227. In order to enroll, you must have the individual’s full name, address, DOB, and their Medicare Part A and/or Part B effective dates. When enrolling, be sure to mark the individual’s eligibility for Medicaid/Medicare Savings Programs, so that there is no delay in the individual’s coverage, and so that you can determine which plans are “benchmark plans” and will not charge the individual a monthly premium for their Part D benefit. It is critical that dual-eligible individuals enroll in benchmark plans to avoid a monthly premium. When conducting an individualized plan search for an individual these plans will be evident by the $0 premium on Medicare’s website. 2025 Oregon Medicare Part D Stand Alone Plans Enrollment can occur directly with a PDP or MA-PD. Medicare Advantage plans that work with a Fully- Capitated Health Plan prefer that the 7208M form is filled out and faxed to them when enrolling a full dual- eligible. This ensures that individuals are more quickly established in the plan’s eligibility and payment systems. Additionally, this form tells the plan that the individual is dual eligible and should not be charged the standard copayments and premiums. There are several different enrollment types and times in which someone can enroll in a plan. These are: • Initial Enrollment Period-beginning 3 months prior to an individuals eligibility for Medicare; • Auto Enrollment; • Facilitated Enrollment: Limited Income Newly Eligible Transition (LI Net); • Special Enrollment Period; • Annual Enrollment Period; • Seamless Enrollment; and, • Retroactive Enrollment Auto enrollment