Enrollment Reconciliation Process

According to CMS as of March 28, 2006, well over a million Medicare beneficiaries are being affected by a systemic problem pertaining to their Part D enrollment. This systems error affects predominately those whose Part D enrollment has been assisted by CMS (either auto or facilitated enrollment), including the full duals, those in Medicare Savings Programs (QMB, SLMB, and QI), those receiving SSI only (but not Medicaid), as well as others who applied for and were granted the low-income subsidy.

CMS and the plans intend to address the enrollment issues of about half of these beneficiaries because they feel the error is easily resolved. The enrollment issues of this group will be reconciled without these beneficiaries having to take action. This group includes:

• Beneficiaries who disenrolled from a plan by switching to another plan
• Beneficiaries whose original plans did not disenroll them following a switch to a different plan AND the original plan has no claims activity (no prescriptions filled).

Approximately 500,000 of this entire group of affected Medicare beneficiaries will receive a letter from the Part D plan to reconcile the enrollment error.  These 500,000 include beneficiaries whose original plans did not disenroll them following a switch to a different plan AND the original plan had claims activity (prescriptions filled). This letter was printed on CMS letterhead but was mailed by the Part D plans. The letters were to have been mailed to these beneficiaries by March 27, 2006 at the latest and provided instructions for beneficiaries either to re-enroll in the original plan or to confirm the disenrollment from the original plan.

For beneficiaries to re-enroll in the original plan, they should have contacted the plan by phone or writing between April 10, 2006 and April 15, 2006 (specified by the letter).

• The plan should have informed CMS of the effective date of the re-enrollment by April 15, 2006.
• If CMS did not receive notification by April 15, the re-enrollment effective date cannot be retroactive.

If the beneficiary did not respond to the plan within the time frame, the plan will confirm the disenrollment from the original plan.

• The plan will disenroll by April 30, 2006 the beneficiary retroactive to the effective date of the original plan switch.
• The plan will not reverse earlier claims for these beneficiaries; these claims will be reconciled between plans.

Finally, all plans must submit full enrollment files to CMS so that CMS can track this information.  It is important to understand that this process is intended to be a one-time synchronization of all plan enrollment information.  Plans will process all future enrollments and disenrollments according to the usual protocol.

Examples of letters beneficiaries may receive from Plans: 

Model PDP letter

Model MA-PDP letter