New York State EPIC Program - Late Enrollment Penalty(LEP) Assistance Changes Effective 10/1/19

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July 30, 2019

Agenda

  1. Background
  2. LEP Changes & Timeline
  3. Q &A

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.
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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.

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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Questions?

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