Please read this notice carefully and keep it where you can find it.
This notice has information about your current prescription drug coverage with the State of Wisconsin (State) or Wisconsin Public Employers (WPE) Group Health Insurance Program and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan under an individual policy. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering individual Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
- The Department of Employee Trust Funds has determined that the prescription drug coverage offered by the state and WPE programs, and administered by Navitus Health Solutions is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year after that from October 15 through December 7. If you lose your state or WPE prescription drug coverage, through no fault of your own, you will also be eligible for a two month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
For Medicare eligible, active working individuals enrolled in the state or WPE group health insurance program, if you decide to join a Medicare drug plan independent of the state or WPE program, your current state or WPE prescription drug coverage will not be affected. You can remain enrolled in the state’s or WPE’s plan and prescription drug coverage through the state or WPE programs will be primary to Medicare Part D. There will be no reduction in your monthly premium if you enroll in another Medicare part D plan. The state and WPE benefit plan design doesn’t allow you to drop prescription drug coverage and maintain medical coverage separately. If you do decide to drop your current state or WPE group health insurance coverage, be aware that you and your dependents may not be able to get this coverage back. Refer to the health benefits materials for more information on re-enrolling in the state or WPE plan and the impact Medicare Part D has on your state coverage.
For Medicare-eligible retired, disabled and COBRA individuals who are not actively working, prescription drug coverage is provided by the state or WPE group health insurance program through a Medicare Part D employer group waiver plan called Navitus MedicareRx (PDP), underwritten by Dean Health Insurance, which is considered creditable coverage. You will be automatically enrolled in the PDP when you become eligible.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
If you drop or lose your current coverage with the state or WPE program and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join another Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join a Medicare drug plan.
For More Information About This Notice or Your Current Prescription Drug Coverage Contact either Navitus or ETF.
Navitus Health Solutions
Phone toll free: 1-866-333-2757
Hours: 24 hours a day, 7 days a week (closed Thanksgiving and Christmas Day)
Navitus MedicareRx (PDP)
Phone toll free: 1-866-270-3877
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
FAX: (608) 267-4549
Web site: etf.wi.gov
P.O. Box 7931
Madison, WI 53707-7931
Wisconsin Relay Service (for hearing & speech impaired)
This notice is provided each year, prior to the next Medicare prescription drug coverage enrollment period or whenever state or WPE coverage changes. You may also request a copy of this notice from ETF at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage
More detailed information about Medicare plans that offer prescription drug coverage is available in the annual “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. While you may also be contacted directly by Medicare PDP providers, you can get more information about Medicare prescription drug coverage from the following sources:
- Visit www.medicare.gov
- Call your State Health Insurance Assistance Program for personalized help
(see the inside back cover of the “Medicare & You” handbook for their telephone number)
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
REMEMBER: KEEP THIS CREDITABLE COVERAGE NOTICE.
If you decide to join one of the Medicare prescription drug plans approved by Medicare you may need to provide a copy of this notice when you join to show that you have maintained creditable coverage and, therefore, are not required to pay a higher premium (a penalty).