Many Low-Income Subsidy Clients May Be Paying Premiums
 Almost 2 million "Extra Help" beneficiaries must switch Part D plans to avoid paying premiums in 2014

According to a report from the Kaiser Family Foundation, 1.9 million Low-Income Subsidy (LIS or "Extra Help") recipients are enrolled in Prescription Drug Plans in 2013 that will not qualify as benchmark plans in 2014.  This number represents about one in four LIS recipients.  Because their plans do not have benchmark status, a status that can change yearly depending on plan bids to CMS, these LIS beneficiaries will have to pay premiums in 2014 if they do not change plans.  Of those affected, roughly 72 percent are already paying premiums because their plan premium was above benchmark in 2013.  About 470,000 LIS enrollees will pay premiums of at least $20 per month and nearly 81,000 will pay premiums of $50 per month unless they change plans. 


The fact that almost two million low-income people may be paying premiums in a program that was designed to relieve them of all premium responsibility is a serious concern for advocates.


CMS automatically reassigns a relatively small subset of these individuals.  Those who were auto-enrolled into a benchmark plan and never chose a different plan will be automatically reassigned to a new plan that has benchmark status on 2014.  That group of reassignees, however, is only about a quarter of those who would pay premiums (CMS has not yet released exact numbers).  The rest, known as "choosers," must affirmatively change plans in order to avoid premium responsibility in 2014.

In some cases it makes sense for an LIS beneficiary to choose to pay premiums because no benchmark plan covers the individual's unique prescription drug needs.  In most cases, however, it appears that inertia is causing beneficiaries to spend extra money that they can cannot afford.


Advocacy Alert:  NSCLC urges advocates to routinely ask their Medicare-eligible clients about their Medicare Part D coverage.

  • If your clients are paying premiums, urge them to review their coverage and consider changing plans.  The Medicare plan finder is an on-line tool beneficiaries and advocates can use to compare plan coverage and costs.
  • If your organization is not equipped to help individuals choose plans, send them to State Health Insurance Program (SHIP) counselors who can assist them.  State SHIP information can be found here

The Medicare Annual Election Period is currently underway and now is a good time for individuals to evaluate their choices.  However, LIS beneficiaries do have a continuous enrollment period, so they can change plans at any time.  The opportunity to help them make cost-saving choices exists throughout the year.



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