(Note: Retirees under age 65 who enroll in an under 65 plan (BCBS PPO+ or Blue Care Elect) will automatically be enrolled in the MIT active group Prescription Drug Benefit.)
Why does MIT offer a Medicare Part D plan?
Under Federal Health Care Reform, Medicare Part D prescription drug plans receive more federal funding than ever before. In addition, these plans are now entitled to discounts from manufacturers of brand name drugs, discounts that are not available to other plans. By converting our plan to a Medicare Part D plan, MIT is able to save money to help continue to pay for comprehensive health care benefits for you and your spouse/partner.
MIT will continue to sponsor your prescription drug coverage and Express Scripts, one of the largest pharmacy benefit companies in the country, will administer your plan. Your coverage conforms to the federal government's Medicare Part D guidelines – but there are no gaps in your coverage because of the "donut hole." (The "donut hole" is when a Medicare Part D plan stops paying benefits and participants are responsible for the full cost of their prescriptions.)
What are the deductible and copayments?
Deductible
There is a $50 annual deductible for Part D drugs except for insulin products and most adult vaccines.
Copayments
| Retail Pharmacy
(30-day supply)* |
Mail Order Pharmacy
(90-day supply) |
|
|---|---|---|
| Generic | $10.00 | $20.00 |
| Brand name preferred | $35.00 | $50.00 |
| Brand name non-preferred | $50.00 | $80.00 |
* You pay one copayment per 30-day supply of medication.
Your premium could be higher based on your income
By law, some MIT plan participants may need to pay an extra premium for Medicare Part D prescription drug coverage if their income is more than $85,000 for a single tax-filer or more than $170,000 for a joint tax-filer. If this premium affects you, you will receive a letter from the Social Security Administration with the amount and payment options.
See Social Security's "Medicare Premiums: Rules for Higher Income Beneficiaries" for additional information or contact them directly at 1-800-772-1213, or TTY 1-800-325-0778. You can also visit the Social Security website to find the office closest to where you live.
What do I need to do?
This prescription drug coverage goes hand in hand with MIT's medical coverage. If you decline MIT's prescription drug coverage, you will no longer have medical coverage through MIT and will therefore need to find new medical insurance. Also, if you decline prescription drug coverage, you will need to be sure you have creditable drug coverage elsewhere or you may be subject to a late enrollment penalty if you enroll in Medicare Part D at a later date.
You will receive a mailing from Express Scripts with full details about your prescription drug plan. You do not have to take any action. If you take no action, your MIT Supplemental health plan coverage will continue and your prescription drug coverage will continue to be administered by Express Scripts as a Medicare Part D Plan. If you want to opt out and decline coverage in MIT's prescription drug plan, you will need to call MIT Benefits within 21 days. Again, remember that you will then need to make sure you have medical insurance as well as creditable prescription drug coverage elsewhere.
What happens if I decide to decline coverage?
This prescription drug coverage goes hand in hand with MIT's medical coverage. If you opt out of MIT's prescription coverage, you will no longer have medical coverage through MIT and will therefore need to find new medical insurance. Also, if you choose to opt out of this coverage, you should consider joining a new prescription drug plan as soon as possible.
If you decide not to join a prescription drug plan and have opted out of this coverage, you may be subject to a late enrollment penalty if you choose to join a Part D prescription plan later. For more information regarding Medicare visit the Medicare website or call Medicare directly at 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048.
New ID card
Only new enrollees will get a new ID card as well as participating network pharmacy information from Express Scripts for their prescription drug coverage in December. This card will be in addition to your medical ID card. Make sure to use your new Express Scripts ID card on and after January 1, when you fill a prescription at a participating retail pharmacy.