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Frequently Asked Questions (FAQ)
I've heard there may be a penalty if I don't enroll in Part D during my Initial Enrollment
Period (IEP). What is my Initial Enrollment Period?
Individuals who become eligible for Medicare will have an Initial Enrollment Period
for Part D that is the seven month period surrounding Medicare eligibility (same
as the Initial Enrollment Period for Part B). The Initial Enrollment Period for
Part B is the seven month period that begins three months before the month an individual
meets the eligibility requirements for Part B and ends three months after the month
of eligibility. If you join after your Initial Enrollment Period, the government
may charge you a penalty unless you can show that you had creditable coverage under
another plan. Creditable coverage is defined as coverage that is, on average, at
least as good as Medicare's Prescription Drug Insurance. For most people, the IEP
occurs three months before you turn 65 and ends three months after the month in
which you turn 65.
What is a formulary?
A formulary is a list of covered drugs.
What is the difference between the Standard formulary and the Enhanced formulary?
The Medi-Pak Rx Basic insurance plan covers all the drugs on the Standard formulary.
The Medi-Pak Rx Classic and Premier insurance plans cover all the drugs on the Enhanced
formulary. The Enhanced formulary covers more preferred brand-name drugs than the
Standard formulary. In addition, the Enhanced formulary covers non-preferred brand-name
drugs. The Standard formulary does not. As required, both formularies include at
least two drugs in every Medicare required therapeutic category and class.
Why are some drugs preferred while others are non-preferred?
First of all, the terms "preferred" and "non-preferred" do not speak to the quality
of a drug nor physicians' preferences. Instead, these terms reflect pricing values.
Simply put: you can save money by choosing brand-name drugs identified as preferred
in our formulary. Of course, generic drugs listed in our formulary are even more
affordable. Please remember — the Basic Plan does not cover non-preferred
drugs.
What if I don't see my drugs on the formulary?
If your prescriptions are not on our formulary, we encourage you to talk to your
physician to see if there are any appropriate alternatives that are included on
the drug list.
The Quick Plan Benefit chart shows that — in Level 2 — if I have the
Classic or Premier Plan, I pay 100 percent of the cost of non-preferred drugs. The
Basic Plan shows non-preferred drugs are NOT covered. In both cases, I have to pay
for the drug. So, what's the difference?
There are two differences. First of all, under the Classic and Premier Plans, even
though you're paying 100 percent of the cost, you still benefit from our negotiated
discount pricing — which you will not receive purchasing a non-preferred drug
if you have the Basic Plan. But most importantly, if you have the Classic or Premier
Plan and you purchase a non-preferred drug which is listed in our formulary, it
counts toward your True Out-of- Pocket (TrOOP). With the Basic Plan, the purchase
of a non-preferred drug — even one listed in our formulary — does not
count toward your TrOOP.
What is TrOOP?
TrOOP (True Out-of-Pocket) is the annual "running total" of the money you (not the
Medi-Pak Rx plan) pay out-of-pocket for prescriptions covered under your plan. It
includes the deductible you pay (if you have Medi-Pak Rx Basic) and any copayments
and/or coinsurance you pay. In 2008, once your TrOOP reaches $4,050, then you move
to Level 3 (See the Quick Plan Benefit chart.)
where you will have very little out-of-pocket costs for covered prescriptions for
the remainder of the year. To ensure your TrOOP is captured accurately, it is very
important that you use our network pharmacies that will file your claims electronically.
Important note: TrOOP does not include your monthly premium.
How do I know my TrOOP?
Each month that you fill a prescription, you will receive an explanation of benefits
that gives you your TrOOP (True Out-of-Pocket) at that point in the year.
What is the "coverage gap?"
This is the point in your prescription drug plan where you are responsible for 100
percent of the costs. (See Level 2 on the chart.) With our Medi-Pak
Rx Premier Plan, you can have coverage for covered generic drugs in "the gap."
What if I'm traveling out-of-state and need to fill or refill a prescription?
Medi-Pak Rx has a large national network. To find the nearest participating pharmacy,
call the toll-free number on the back of your ID card or on the
Web site.
Will I benefit from Medi-Pak Rx even when I'm paying 100 percent of my prescription costs?
Absolutely. When you give an in-network pharmacist your Medi-Pak Rx card, you are
guaranteed to receive our negotiated discount price.
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