Questions and answers for retired STATE participants
covered under the State's Group Health Insurance Program
What is Medicare Part D?
Medicare Part D is a prescription drug benefit program created
by the federal government, which was originally effective on January
1, 2006. Medicare eligible beneficiaries can enroll in Medicare
Part D coverage through an approved prescription drug plan starting
each November 15th, for coverage effective January 1st, of the following
year. Participation in Medicare Part D is voluntary.
I have prescription drug coverage through the state's
group health insurance program. Should I enroll in a Medicare Part
D prescription drug plan (PDP) when I become eligible?
We recommend against it. Keep in mind you are already paying for
and receiving comprehensive prescription drug coverage through the
state's group health insurance program. The Department of Employee
Trust Funds has determined that your current drug coverage, administered
through Navitus Health Solutions, is "creditable coverage"
in comparison to the Medicare Part D prescription drug benefit.
This allows you to defer enrollment in Part D without penalty (refer
to the question below, "Will Medicare penalize me if I do not
enroll in Medicare Part D?").
You should carefully consider all options before making any kind
of enrollment decision. 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 PDP?
No. The health insurance premium printed in the It's Your Choice
booklet for annuitants and continuants (ET-2108) includes both medical
and prescription drug coverage and is already reduced to account
for the Retiree Drug Subsidy (RDS). Under the RDS program the Employee
Trust Funds is eligible for a reimbursement of a portion of the
pharmacy claims paid for retirees who are not enrolled in Medicare
Part D. This subsidy is applied directly to the pharmacy portion
of premiums under the State program. If you enroll in a Medicare
PDP, you will continue to pay the same premium to the State, in
addition to paying the Medicare PDP premium (approximately $38/month)
for the plan you choose. Navitus will coordinate coverage with Medicare
and pay after Medicare processes your prescription claims, minus
the applicable copayments and coinsurance that are your responsibility.
are PDP.
Will Medicare penalize me if I do not enroll in Medicare
Part D?
No. Because coverage through the State of Wisconsin Group Health
Insurance Program is, on average, as good as if not better than
the standard Medicare prescription drug coverage (i.e. "creditable
coverage", you will not have to pay a penalty if you enroll
later. The certificate of creditable coverage is located in your
It's Your Choice booklet in Section B.
Where can I get more information about how my pharmacy
benefits are affected by the Medicare Part D program?
For more information about your current prescription drug coverage,
or your options under Medicare prescription drug coverage, refer
to your copy of the It's Your Choice booklet or contact Navitus
or ETF.
Navitus Customer Care
Phone toll free: 1-866-333-2757
Hours: 24 hours a day, 7 days a week (Closed Thanksgiving and
Christmas Day)
Department of Employee Trust Funds
Phone toll free: 1-877-533-5020
Local to Madison: 608-266-3285
Web site: http:\\etf.wi.gov
Mailing Address:
P.O. Box 7931
Madison, WI 53707-7931
For information about Medicare benefits and how to enroll contact
your local Social Security Administration office or call 1-800-772-1213.
More detailed information about Medicare plans that offer prescription
drug coverage is available in the “Medicare & You”
handbook, which is updated annually. You will get a copy of the
handbook in the mail from Medicare when you become eligible.
In addition, The State Health Insurance Assistance Program (SHIP)
has counselors in every State and several Territories that are available
to provide free one-on-one help with your Medicare questions or
problems. A list of SHIP counselor who are in your area can be found
at their web site. The Wisconsin SHIP contact can be reached at
either 1-800-242-1060 or 1-866-456-8211.
Other resources for you include the following:
- Visit www.medicare.gov
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
- Prescription Drug Helpline: Phone toll free:
1-866-456-8211, Mon. - Fri.
- Medigap Helpline: Phone toll free: 1-800-242-1060
(leave a message)
- Wisconsin Coalition for Advocacy
Information and resources for Medicare beneficiaries who receive
disability benefits.
- Phone toll free: 1-800-926-4862, Monday through Friday
- For people with limited income and resources, extra help paying
for a Medicare prescription drug plan is available. Information
about this extra help is available from the Social Security Administration
(SSA). For more information about this extra help, visit SSA online
at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY
1-800-325-0778).
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