One of the long-term ripple effects of the Medicaid Unwinding completed earlier this year is that a larger than normal number of Medicare beneficiaries will lose Extra Help coverage as of Dec. 31, 2024. Beneficiaries losing their Extra Help coverage will be receiving this notification (also referred to as a “gray notice”) from the Centers for Medicare and Medicaid Services (CMS). Avisery recommends these beneficiaries reapply for Extra Help coverage now to help avoid a potential lapse in Extra Help coverage starting in January.
Background
Individuals who receive at least one month of Medicaid or are enrolled in a Medicare Savings Program are "deemed eligible" for the Extra Help Program and will be automatically enrolled and receive assistance paying for their prescription drug costs. Extra Help approval periods for beneficiaries deemed eligible through their Medicaid status last anywhere from 8 months to 1.5 years, depending on the month of the year the individual enrolled in Medicaid.
Due to the federally-mandated continuous coverage provisions put in place during the Covid-19 Public Health Emergency (PHE), all Medicaid customers were allowed to maintain their coverage regardless of changes to their financial situation.These populations also maintained their deemed eligibility for the Extra Help program. Between July 2023 and June 30, 2024, Illinois Medicaid "unwound" from the PHE-related continuous coverage provision by re-determining eligibility for all Medicaid customers.
Individuals enrolled in Medicare who lost their Medicaid coverage during this unwinding period can anticipate losing their Extra Help coverage as of January 1, 2025. These beneficiaries will likely see an increase in the cost of their prescription drug coverage unless they re-enroll in the Extra Help program. They can re-enroll either by applying directly through the Social Security Administration or by re-enrolling in full AABD Medicaid, meeting a Medicaid spenddown for at least one month, or enrolling in a Medicare Savings Program.
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Avisery by AgeOptions provides tools and support to professionals serving older adults and people with disabilities, enabling them to help their clients access healthcare coverage that allows them to thrive as they age. Contact us at avisery@ageoptions.org or 708-628-3440.
AgeOptions, 1048 Lake Street, Suite 300, Oak Park,IL,60301,United States,(800) 699-9043
