Our Case Mangers and SHIIP Counselors have been striving to ensure that those in our area who have lost their drug coverage with Indy Health get the best service possible during this difficult transition. Over 40,000 beneficiaries have been affected by this change with the majority being in AR, GA, IL, PA and WV. Beneficiaries will be receiving three letters – from Indy, CMS, and LI-NET. We have been notified by some clients that they have already received letters from Indy Health.
We have also been informed that some clients received phone calls or voicemails informing them of their temporary coverage with LI-Net administered by Humana. The Limited Income NET (LI-NET) Program is designed to eliminate gaps in coverage for low-income individuals transitioning to Medicare Part D drug coverage. In this instance it is bridging the gap between the cancellation of your Indy Health coverage and the beginning coverage of your chosen plan.
Please Note: “While the LI-NET program is administered by Humana through a contract with CMS, beneficiaries are not required to join a Humana plan outside the temporary assistance through LI-NET. “
The pharmacies have been notified about the Indy Health situation. Do not be surprised if your pharmacist asks for your Medicare number in order to file with LI-Net.
The following FAQs were provided from SHIIP:
Will Medicare individuals have to pay another deductible amount with the new plans, if the individual met their deductible under Indy Health?
No, but it may take a bit of time for the systems to sync up to accurately reflect a beneficiary’s true out-of-pocket costs (TROOP), which includes the deductible amounts paid.
Will the Medicare individual have to pay a monthly premium with getting medications through Li-Net? While there’s typically no premium or deductible for LI NET, in reading into LI NET materials, if a person is granted LI NET temporarily and then later is found to not qualify, then the bene is responsible for the costs incurred while temporarily in the program.
Correct. There’s no deductible or premium in LI-NET. The Indy beneficiaries in LI-NET for March and April won’t later be found to “not qualify”.
Some Medicare individuals paid Indy Health Monthly premiums in advance of 6 month or yearly. How will individuals be refunded?
Indy talking points for premium credits/refunds:
- I have a premium credit, so will I get a refund?
Indy Health is currently working through the number of beneficiaries and amounts of premium dollars that will require a refund. Once this analysis is complete, we will be working with the Department of Insurance to issue refunds in accordance with the Rehabilitation process.
- I paid March’s premium, so what happens?
LI-Net (the plan you were auto-assigned to) will process claims for the remainder of March without you having to pay an additional premium.
If you paid a March premium by check, Indy Health is currently working through the number of beneficiaries and amounts of premium dollars that will require a refund. Once this analysis is complete, we will be working with the Department of Insurance to issue refunds in accordance with the Rehabilitation process.
If you paid a March premium out of the SSA/RRB withhold program, Social Security/RRB will work to credit you this amount.
Some individuals are finding it cheaper to get medications from other programs and pharmacies are suggesting they can wait till July 2021 to enroll in a drug plan. When will Medicare put them in another plan? Can they wait until July?
Beneficiaries were moved into LI-NET on a temporary basis right now with an effective date of 3/1. If the Indy beneficiaries do not make an election, then CMS will passively enroll beneficiaries into the plans listed below with an effective 5/1/2021 date:
- PA S5884-104
- WV S5884-104
- GA S5884-135
- IL S5884-107
- AR S5884-141
Beneficiaries can choose and join a different Medicare drug plan (vs. the one CMS passively enrolls them in) anytime between now and July 31, 2021. The new coverage can start as early as the month after they join (as soon as May, today’s date is 4/5/2021).
