Department of Employee Trust Funds - Hot Topic
July 28, 2005 (Updated 10/03/2005)
Questions from STATE participants covered under
the State’s Group Health Insurance Program
What is Medicare Part D?
It is a new prescription drug benefit program administered by the
federal government. Enrollment in Medicare Part D coverage begins
November 15, 2005, for coverage effective January 1, 2006.
I have prescription drug coverage through the state’s
group health insurance program. Should I enroll in a Medicare Part
D prescription drug plan when I become eligible?
State retirees: Keep in mind you are already paying for and
receiving comprehensive prescription drug coverage through the state’s
group health insurance program. Your current drug coverage,
administered through Navitus Health Solutions, is creditable coverage
in comparison to the Medicare Part D prescription drug benefit.
This coverage will allow you to defer enrollment in Part D without
penalty. Nevertheless, you should carefully consider all options
before making any kind of enrollment decision. Participation in
Medicare Part D is voluntary and in 2006 you will pay a monthly
premium of about $38. If you would like to maintain your current
level of prescription drug benefits under our program, it is not
necessary to enroll in Medicare Part D at this time.
Will my State health insurance premium go down if I enroll
in a Medicare Part D prescription drug plan?
No. Your health insurance premium includes both medical and prescription
drug coverage and is already reduced to account for the Medicare
drug subsidy. If you enroll in a Medicare prescription drug plan,
you will continue to pay the same premium in addition to paying
the Part D premium (approximately $38/month) to Medicare. Navitus
will coordinate coverage with Medicare and pay after Medicare processes
your prescription claims, minus the applicable copayments and coinsurance
that are your responsibility.
Where can I get more information about how my State employee
program pharmacy benefits would be affected if I enroll in the Medicare
Part D program?
The Department of Employee Trust Funds will communicate with you
in several ways. Information will be available in the 2006 It’s
Your Choice booklet, in the September edition of the It’s
Your Benefit Newsletter, and on the Department’s Internet
site. The Department also plans to mail letters to retirees in September
explaining how pharmacy benefits are affected by Medicare Part D.
I am covered under the Wisconsin Public Employers (WPE)
Program. How does Medicare Part D affect my prescription drug coverage?
Should I enroll in a Part D Prescription Drug Plan?
Yes, you should enroll in the Group Insurance Board’s preferred
Medicare Prescription Drug Plan (PDP), Dean Health Insurance, Inc.
(DHI). Your premium already includes the cost of Medicare
Part D coverage through DHI. Information about how to enroll
will be sent to you by DHI. Navitus will work directly with DHI
to ensure that your Medicare Part D benefits are coordinated with
your coverage under this plan. If you choose to enroll in a PDP
other than DHI, you will not receive a reduction in premium, and
you may experience additional expenses as Navitus will only coordinate
benefits as though you were enrolled in DHI. If you do not enroll
in a Part D PDP, your prescription drug claims will be paid as though
you had Medicare Part D coverage. This means that you will be responsible
for the portion of your claims that DHI would have paid, hence more
out of pocket costs for you. In all cases, you will be responsible
for the prescription drug copayments outlined in Uniform Benefits.
Other resources for you include the following:
Navitus Customer Service
Phone toll free: 1-866-333-2757
Regular Hours: 7 a.m. - 9 p.m. CST, Monday through Friday
Holiday Hours: 8:30 a.m. - 5p.m. CST, (Closed Thanksgiving and
Department of Employee Trust Funds
Phone toll free: 1-877-533-5020
Local Madison: (608) 266-3285
Prescription Drug Helpline
Phone toll free: 1-866-456-8211, Monday through Friday
Phone toll free: 1-800-242-1060 (leave a message)
Wisconsin Coalition for Advocacy
Information and resources for Medicare beneficiaries who receive
Phone toll free: 1-800-926-4862, Monday through Friday
Wisconsin Benefits Specialists Program
To locate your benefits specialist, contact your County Aging
Unit or the Department of Health and Family Services-Bureau of
Long Term Care Resources
Phone: (608) 266-2536; TTY: (608) 267-9880.
for Medicare and Medicaid Services Fact Sheet
Medicare D Letter Sent to Annuitants
September 28, 2005
Wisconsin Medicare D Resource