STATE HEALTH BENEFITS
SCHOOL EMPLOYEES' HEALTH BENEFITS
MEDCO MEDICARE PRESCRIPTION DRUG PLAN
SHBP/SEHBP RETIREE PRESCRIPTION DRUG COVERAGE
Effective January 1, 2012
QUESTIONS AND ANSWERS
1. Q. What changes are being made to retiree prescription drug coverage?
A. Retirees and/or covered spouses/partners who are eligible for Medicare will be enrolled through Medco in Medicare Part D prescription drug coverage. Medco will remain the prescription drug plan administrator for these retirees and coverage in the Medco Medicare Prescription Drug Plan will be similar to the current Medco plan — i.e. members pay the appropriate copayment for either a retail or mail order prescription drug order.
The change does not apply to covered children who are eligible for Medicare, who will remain covered under the current Medco plan.
2. Q. Do I need to do anything because of the change?
A. No. The SHBP/SEHBP and Medco will automatically enroll eligible retirees into Medicare Part D and the new Medco Medicare Prescription Drug Plan. Retirees should not actively enroll separately into Medicare Part D or into a privately offered Medicare Part D plan.
As with all SHBP/SEHBP coverage, retirees who are eligible for Medicare must enroll in and maintain both Medicare Part A (Hospital) and Part B (Medical) coverage.
Note: Retirees should carefully review plan options if comparing Medicare D plans. Retired members, and/or dependents, who enroll in privately offered Medicare Part D plans will lose their SHBP or SEHBP prescription drug coverage. In addition, the SHBP and SEHBP will not cover the costs of any drugs that are not covered by the Medicare Part D plan.
3. Q. Why are these changes being made?
A. The change was made by the SHBP/SEHBP’s Plan Design committees. The change will provide significant savings to the programs each year, which will help to lower premium increases.
4. Q. Will I have to pay more for my medications because of the Medicare Part D “donut hole”?
A. No. The Medco Medicare Prescription Drug Plan provides “wrap-around” coverage that eliminates the “donut hole” (the “donut hole” is a part of some Medicare Part D plans where members pay the full cost of prescription drug orders). Because of the “wrap-around” coverage, SHBP/SEHBP members only pay the appropriate copayment for prescription drug orders, up to any annual maximum out-of-pocket amounts.
5. Q. Are there any other costs associated with this coverage?
A. Because you are being enrolled into Medicare Part D, some members will have the monthly premium for Part D coverage deducted from their Social Security benefit. Members who earn more than $85,000 per year ($170,000 if married and filing jointly) will have a deduction as follows:
|YOU PAY IN 2012
||IF YOUR YEARLY INCOME IS
|Your Plan Premium*
||$85,000 or less
||$170,000 or Less
|$11.60 + Your Plan Premium
||$85,001 - $107,000
||$170,001 - $214,000
|$29.90 + Your Plan Premium
||$107,001 - $160,000
||$214,001 – $320,000
|$48.10 + Your Plan Premium
||$160,001 – $214,000
||$320,001 - $428,000
|$66.40 + Your Plan Premium
*If you do not currently pay a premium for you SHBP/SEHBP coverage, you will continue to not pay a premium under this plan.
State or Local Education retirees who qualify for reimbursement of their
Medicare Part B premiums will also be eligible for reimbursement by the
State for Part D premiums. The Part D reimbursements will be paid in the
same manner as the income-related Medicare B premiums: once a year, upon
receipt of proof of the premiums paid.
Local Government retirees may qualify for reimbursement of Medicare Part D
premiums if the employer participates in the SHBP and provides
reimbursement under the provisions of Chapter 88, P.L. 1974 or Chapter 48,
P.L. 1999. Reimbursement of Local Government retirees is coordinated
and paid through the former employer.
6. Q. Can I continue to use my current pharmacy?
A. You will have access to over 63,000 network pharmacies nationally, including mail-order services through the Medco Pharmacy. If your pharmacy currently accepts your commercial Medco plan from the SHBP/SEHBP, you will be able to continue using that pharmacy with the Medco Medicare Prescription Drug Plan. However, if your pharmacy is one of the few that do not accept Medicare Part D plans, you will be required to use a participating pharmacy in order to use the SHBP/SEHBP prescription drug benefits through the Medco Medicare Prescription Drug Plan. Veteran Administration pharmacies do not participate in this plan.
7. Q. Where can I get more information?
A. In mid-December you will receive a Welcome Packet Adobe PDF (292K) from Medco explaining the new Medco Medicare Prescription Drug Plan. You will also receive a new Medco Medicare Prescription Drug Plan ID card.
After reviewing the information in the Welcome Packet, specific questions can be directed to the Medco Medicare Prescription Plan — 24 hours a day, 7 days a week — at
1-866-544-9703. TTY/TDD users can call 1-800-716-3231.