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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).