DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
Center for Medicaid and State Operations 
SMDL # 06-002 
February 17, 2006 
Dear State Medicaid and State Pharmaceutical Assistance Program Directors: 
 
As you help people with Medicare compare Medicare drug plans and make a choice that works for them, or enroll them in plans as 
their authorized representative under state law, it is also important to consider the timing of each enrollment. 
Generally, if a person with Medicare enrolls in a Medicare drug plan, or changes plans, at the beginning of the month, he or she will 
be able to get the most out of their coverage from the first day it is effective. Enrollments early in the month give Medicare and drug 
plans time to update their systems, and mail important information like a membership card, acknowledgement letter, and welcome 
package to enrollees before their coverage becomes effective. In these cases, even if a person with Medicare goes to the pharmacy on 
the first day of coverage, they can get their prescriptions quickly and accurately. 
Enrollments and plan changes later in the month make it far less likely that all of the information needed to file the claim correctly will 
be available at the pharmacy or the plan on the first day of coverage. For enrollments being processed later in the month, it is 
important to provide the enrollee with some extra information to help manage expectations and help the person successfully fill 
prescriptions. This information is especially important because a person who enrolls late in the month might not receive an 
acknowledgement or confirmation letter, or a membership card by the day the coverage starts. In these cases, if the enrollee needs to 
fill a prescription, he or she should be provided with the following advice: 
  If the enrollee has received one, bring any acknowledgement, confirmation, or welcome letter to the pharmacy until a 
membership card arrives. 
  If he or she has not received a letter confirming enrollment, obtain an enrollment confirmation number or membership 
number from the plan, and give the number to the pharmacy. 
  If the enrollee has both Medicare and Medicaid, or has been approved for the low income subsidy (extra help paying for 
prescriptions), bring a copy of the yellow automatic enrollment letter from Medicare, a Medicaid card, an approval letter 
from the Social Security Administration, or other proof that he or she qualifies for extra help. 
  If the enrollee needs to get a prescription before receiving a letter or membership card, let the pharmacist know the Medicare 
drug plan name and bring one of the items above to get prescriptions filled, and be aware that it may take some extra time. 
  As a last resort, if the enrollee must pay out-of-pocket for the prescription, he or she should save the receipts and work with 
the Medicare drug plan to be reimbursed. 
We recognize that some beneficiaries will become entitled late in the month and that we cannot avoid some enrollments being 
processed late in the month. We are working to streamline the process so that these beneficiaries will have the information they need 
to get their prescriptions filled as quickly as possible. However, systems processing takes some time and we are hopeful that by 
enrolling as many as we can early in the month, and providing additional information to those enrolling in the second half of the 
month, we will make the process work as smoothly as possible for our beneficiaries. 
Thank you again for your continued assistance as we work to implement the new Medicare prescription drug coverage. 
 
Sincerely, 
 
    /s/   
Dennis G. Smith 
Director 
Enclosures 
cc: 
CMS Regional Administrators 
CMS Associate Regional Administratorsfor Medicaid and State Operations 
HHS Regional Directors 
Martha Roherty, Director, Health Policy Unit, American Public Human Services Association 
Joy Wilson, Director, Health Committee, National Conference of State Legislatures 
Matt Salo, Director of Health Legislation, National Governors Association 
Jacalyn Bryan Carden, Director of Policy and Programs, Association of State and Territorial Health Officials 
Lynne Flynn, Director for Health Policy, Council of State Governments 
Christie Ramszewski Herrera, Director, Health and Human Task Force, American Legislative Exchange Council