New Safety Net System for Low-Income Beneficiaries Without a Part D Plan

CMS announced a new system to help beneficiaries who receive the Part D low-income subsidy (LIS) have better access to their prescription drugs when they’re not enrolled in a Part D plan. As of January 1, 2010, this system will replace the current Point of Sale (POS) system operated by WellPoint. The new system is called Limited Income Newly Eligible Transition (LI NET) program, and Humana has been awarded the CMS contract to operate it.

The POS system is designed to provide temporary prescription drug coverage when someone who is enrolled in the LIS is not enrolled in a Part D plan. This can happen for a variety of reasons, including if there’s a glitch in the system and people who are supposed to be auto-enrolled in a Part D plan aren’t, or if a beneficiary experiences a time gap from when they are found LIS eligible and when their Part D plan enrollment becomes effective.  The POS system gives people coverage and therefore access to their prescription drugs AND at the same time randomly enrolls the people using the POS system into a Part D benchmark prescription drug plan.

Starting in 2010, the new system, LI NET, in addition to offering temporary drug coverage and prospective random enrollment into a Part D plan for uncovered LIS-eligible beneficiaries, it will also offer some retroactive coverage to uncovered LIS eligible beneficiaries and full-benefit dual eligible and SSI-only beneficiaries.  Uncovered full-benefit dual-eligible and SSI-only beneficiaries will have retroactive coverage up to at least 36 months, while all other beneficiaries with LIS will have retroactive coverage for 30 days.

For more information, see CMS’ webpage. It contains a helpful fact sheet (PDF) and ppt presentation on the new LI NET program.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.