New York State EPIC Program
Late Enrollment Penalty(LEP) Assistance Changes Effective 10/1/19
- Document is also available in Portable Document Format (PDF)
July 30, 2019
Agenda
Background
- The Late Enrollment Penalty (LEP) is an amount added to the Medicare Part D premium when the member did not enroll in a Part D plan, or have creditable coverage when first eligible.
- The cost of the late enrollment penalty depends on how long the member went without Medicare Part D or creditable prescription drug coverage.
- The Medicare Part D monthly premium, plus the LEP payment, cannot exceed the monthly Benchmark amount & the member is responsible for any remaining balance over the Benchmark amount.
- EPIC´s financial assistance for LEPs was intended to support members through the Medicare Part D implementation and transition period.
- Awareness of LEP support is typically through EPIC outreach activities and/or the member´s interaction with Part D plans, or individuals providing enrollment assistance such as HIICAP counselors or NY Connects staff.
- Significant improvements to assure member awareness of enrollment requirements have been made, since the inception of Medicare Part D in 2006.
- For 2018, EPIC paid LEPs for ˜1300 members at an annual cost of ˜$37.00 per member.
LEP Changes – Effective 10/1/19
- Existing EPIC members that have not had LEP assistance, and new EPIC members, will not be entitled to such assistance.
- EPIC members that are currently being provided with LEP assistance will be “grandfathered” and will continue to get such assistance.
- This change aligns with other historical EPIC changes that support Medicare Part D requirements and coverage parameters.
LEP Changes –Timeline
Step | Target Date |
---|---|
Respond to stakeholder questions | Ongoing |
Webinar (if needed) for stakeholders with direct member contact (e.g. HIICAP Counselors, NY Connects Staff) | By 8/15/19 |
Written Notices to Part D Plans & direct contact stakeholders (e.g. HIICAP Counselors, NY Connects Staff) | 9/1/19 |
Go Live | 10/1/19 |
Member Helpline:
- 1–800–332–3742
- (TTY 1–800–290–9138)
Web: http://www.health.ny.gov/health_care/epic/
Email: NYSEPICOutreach@magellanhealth.com
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