Prescription Drug Plan Reassignment
Guidance for low income beneficiaries from PDPs that are going above the regional LIS benchmark (and did not, or could, not waive a de minimis amount of premium above the benchmark), and from PDPs and MA plans that are terminating (which includes MA plans that are reducing their service areas).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 17, 2018
Each year CMS reassigns low income beneficiaries from PDPs that are going above the regional LIS benchmark (and did not, or could, not waive a de minimis amount of premium above the benchmark), and from PDPs and MA plans that are terminating (which includes MA plans that are reducing their service areas). These beneficiaries are reassigned into a PDP that is below the regional LIS benchmark. CMS does not reassign beneficiaries that are LIS eligible with 100% premium subsidy and have voluntarily elected a plan, otherwise referred to as “choosers”, unless the plan in which the beneficiary is enrolled is terminating or reducing its service area and the beneficiary would be left with no Part D coverage. The link below sets out the counts of beneficiaries reassigned by reason (i.e. premium increase, plan termination), by region and by effected PDP sponsor.
Each year before CMS processes reassignments, it sends to plans via the Health Plan Management Systems memorandums reiterating the parameters of reassignment, providing updates that will affect reassignment for a given year, and providing key dates to plans so that they will know what to expect. One memorandum relates to the annual PDP reassignment, which affects PDPs going above the regional LIS benchmark and terminating PDPs. The other memorandum is the annual MA reassignment, which relates to terminating MA plans, and MA plans reducing their service areas. Below is a list of these memorandums beginning with the 2016 reassignments for effective dates of January 1, 2017. Each year thereafter we will add the current year's memorandums.
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