DSS: ConnPACE Changes

ConnPACE Changes


 
Overview
  • Under the new state budget for the fiscal year beginning July 1, 2011, Connecticut will be closing the ConnPACE prescription drug assistance program for individuals who are enrolled in Medicare.
Most current ConnPACE enrollees will not be impacted, and do not have to take any action
  • Nearly all 25,000+ ConnPACE beneficiaries are already in Medicare and its Part D prescription drug assistance coverage.  The great majority are also already enrolled in the State of Connecticut’s Medicare Savings Programs, which automatically qualifies them for the Medicare Part D Low-Income Subsidy (also known as ‘Extra Help’).  This means the great majority will not be affected by the loss of ConnPACE on July 1, because the combination of Medicare Part D and the Low-Income Subsidy/Extra Help will provide prescription drug coverage. 
However, about 5,500 ConnPACE enrollees need to join Medicare Savings Programs to avoid impact
  • About 5,500 of the ConnPACE beneficiaries who are also in Medicare and its Part D prescription drug coverage are not yet enrolled in the Medicare Part D Low-Income Subsidy/Extra Help.  The easiest way to enroll in the Low-Income Subsidy/Extra Help is to enroll in Connecticut’s Medicare Savings Programs.  If they do not enroll, these individuals could be significantly affected by the loss of ConnPACE on July 1, especially if they’re in the Medicare D “donut hole,” where they would be responsible for the entire cost of their prescriptions.                                  

  • In summary, this group will be at risk of losing prescription drug benefits now covered by ConnPACE unless they enroll in the Medicare Low-Income Subsidy/Extra Help by applying for the Medicare Savings Programs before the closure of ConnPACE on July 1.

  • To avoid disruption in their prescription coverage, these individuals need to submit their Medicare Savings Programs applications as soon as possible, because the ConnPACE program will not be available to them as Medicare beneficiaries, beginning July 1, as a result of the state budget change.

  • The Department of Social Services is reaching out to these ConnPACE beneficiaries with enrollment information and applications for the Medicare Savings Programs.
Qualifying for federal ‘Low-Income Subsidy/Extra Help’ is automatic by enrolling in Connecticut’s Medicare Savings Programs
  • The budget change coming July 1 recognizes that all individuals now eligible for ConnPACE and Medicare can easily be eligible for the Medicare Low-Income Subsidy/Extra Help.  They become automatically eligible for the Low-Income Subsidy/Extra Help simply by taking the step of enrolling in the state Medicare Savings Programs.

  • The eligibility criteria for ConnPACE are the same as in the Medicare Savings Programs, which means that individuals eligible for ConnPACE and Medicare can sign up for the Medicare Savings Programs at no cost.
Benefits to Enrollees and the State Budget
  • Individuals who enroll in Connecticut’s Medicare Savings Programs benefit from lower costs through the federal Medicare Part D program’s Low-Income Subsidy/Extra Help.

  • For example, Medicare Part D co-pays will be $6.30 or less.  This also means that Medicare will cover the entire monthly premium if the individual is enrolled in a Connecticut-approved Medicare Part D benchmark plan; and will pay a portion of the individual’s monthly Part D premiums if he/she is enrolled in a non-benchmark plan.

  • Also, with the Low-Income Subsidy/ Extra Help benefit, individuals may switch to a different Medicare Part D Plan at any time; there is no need to wait for the open enrollment period.

  • Joining the Medicare Savings Programs also means that monthly Medicare Part B premiums ($96.40-$115.40 per month) are paid on enrollees’ behalf, which means they receive more in Social Security benefits every month.

  • Some individuals who enroll in the Medicare Savings Programs may even qualify to have their 20% co-insurance and Medicare deductibles covered by the state.

  • In the process, the state benefits by avoiding customary costs through ConnPACE. 
For more information about enrolling in the Medicare Savings Programs
 
The letters to ConnPACE members advise them to call the ConnPACE toll-free line or
2-1-1 Infoline, as below:
  • For questions about the ConnPACE program, please call ConnPACE at 1-800-423-5026 or (860) 269-2029.

  • For questions on the Medicare Savings Programs, please  call 2-1-1 (Infoline, toll-free) or visit www.ct.gov/dss/MedicareSavingsPrograms
ConnPACE enrollment fee refund information
  • For Medicare beneficiaries who have enrolled or re-enrolled in ConnPACE, the Department of Social Services will be issuing enrollment fee refunds on a pro-rated basis if their annual enrollment or re-enrollment period began April 1, 2011, or later.  (In April, the General Assembly’s Appropriations Committee voted for a budget bill containing the elimination of the ConnPACE program for Medicare beneficiaries, effective July 1, 2011, indicating the likelihood of legislative approval of the measure.)

  • DSS will be pro-rating the refunds of the annual $45 enrollment fee at $3.75 per month.  This means that enrollees whose renewal period began April 1 will receive a refund of $33.75; enrollees whose renewal period began May 1 will receive a refund of $37.50; and enrollees whose renewal period began June 1 will receive a refund of $41.25.  Over 8,400 individuals will receive refunds, with the total amount reimbursed expected to be approximately $320,000. 
ConnPACE is not being completely eliminated 
  • ConnPACE will continue for a small number of recipients who are not enrolled in Medicare.  Therefore, they are not eligible for the Medicare Savings Programs and, by extension, the federal Low-Income Subsidy/Extra Help.  For these 100 or so beneficiaries, ConnPACE will remain as a prescription drug assistance program. For more information about ConnPACE, visit www.ConnPACE.com.

  • In addition, new applicants for ConnPACE who are not enrolled in Medicare may also be eligible for ConnPACE when applying during the open enrollment period of November 15 through December 31; or within 31 days of their 65th birthday; or within 31 days of qualifying for federal Social Security income benefits.
Special information for individuals with prescriptions for benzodiazepines and barbiturates:
 
ConnPACE recipients who are also in Medicare, and who will be disenrolled from ConnPACE on July 1, 2011, due to the state budget change, will no longer have coverage for Medicare Part D-excluded drugs; i.e., benzodiazepines and barbiturates.  Program records show that approximately 200 ConnPACE beneficiaries accessed these medications in the first quarter of calendar year 2011.  Excluded drugs are not coverable under Part D, but may be offered as an additional benefit in some enhanced plans such as a Medicare Advantage Plan.  Individuals may call the CHOICES health insurance counseling service at 1-800-994-9422 to receive a full Part D screening to find out what plan may fill in this gap.  Beginning January 1, 2013, Medicare Part D will be expanded to include coverage of barbiturates and benzodiazepines.      


Content Last Modified on 8/9/2011 10:18:50 AM