Dartmouth / SilverScript Retiree Prescription Drug Plan

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1 Dartmouth / SilverScript Retiree Prescription Drug Plan

2 Agenda What s Happening /Why the Change? What is Medicare Part-D? Who is SilverScript? How is this affecting my Dartmouth coverage? What do I need to do? What resources are available? Questions?

3 What s Happening/Why The Change The 2010 Patient Protection and Affordable Care Act Introduced reimbursements to the Medicare Part D prescription drug plan to employers such as Dartmouth who offer prescription drug coverage to their retirees as an incentive to continue offering prescription drug coverage EGWP +Wrap In order to take advantage of these new federal reimbursements, Dartmouth is moving to a Medicare Part D-based plan called EGWP (Employer Group Waiver Plan) and providing a Wrap (or supplemental) plan to fill in the Part-D coverage gap (a.k.a. the donut hole) Retiree Health Subsidy Will be applied to your coverage as a household You will receive one invoice including coverage for both you and any of your covered dependents SilverScript Effective January 1, 2013, SilverScript (a subsidiary of CVS Caremark) will administer this EGWP +Wrap prescription drug plan for Dartmouth retirees and Medicare eligible dependents 3

4 What is Medicare Part D? Medicare Part D is Medicare Prescription Drug coverage The Medicare Part D program began on January 1, 2006 Medicare Part D is administered by private insurance companies but funded by Center for Medicare & Medicaid Services (CMS) Medicare Programs run on a calendar year basis 4

5 SilverScript & Dartmouth Post 65 Retiree Prescription Drug Plan The prescription drug portion of the Dartmouth College Medicare Supplement (DCMS) Plan, for Medicare eligible retirees enrolled in the Dartmouth supplemental plan, will now be administered by SilverScript, a subsidiary of CVS Caremark This SilverScript Prescription Drug plan consists of two parts: Medicare Part D Plan which is the same benefit coverage as the Medicare Part D program offered by the federal government Secondary or Wrap Plan - A prescription drug plan provided by Dartmouth, which covers the gaps in the Medicare Part D program to provide a benefit that s more comprehensive than Medicare Part D alone The two parts together are designed to mirror your current coverage 5

6 64,000+ Pharmacies Across the Nation (includes CVS and non-cvs contracted pharmacies) CVS Caremark Medicare Part D Pharmacy Network NJ 1,942 AK 108 OR 679 CA 5,742 WA 1,255 NV 482 AZ 1,121 MT 277 ID 324 WY 124 UT 487 HI 195 CO 833 NM 339 ND 163 SD 213 NE 452 KS 610 TX 4,261 OK 883 MN 1,135 IA 767 IL IN 2,359 1,225 MO 1,275 AR 750 LA 1,106 WI 1,158 MS 807 MI 2,412 KY 1,129 TN 1,622 AL 1,329 OH 2,401 WV 529 PA 2,987 NC 2,016 SC 1,137 GA 2,296 FL 4,307 NY 4,572 VA 1,557 ME 286 VT 141 NH 266 MA 1,166 RI 198 CT 650 DE 181 MD 1,172 D.C. 114 PR 991 Source: CVS Caremark Network Management as of May 19,

7 Part D Employer Group Waiver Plan (EGWP) SilverScript Medicare Part D Prescription Drug Plan is primary coverage Dartmouth College Medicare Supplement (DCMS) plan is secondary (or supplemental) coverage One single ID card per member reflecting both plans Transactions between the Primary SilverScript and the Dartmouth Wrap (or supplemental) coverage will be seamless How the plan works - The Member picks up a prescription at their local pharmacy. If it s not covered under the SilverScript Part D plan, Dartmouth will supplement the cost of medications currently covered under our program, * according to the format of the DCMS prescription coverage. Dartmouth Wrap (Supplemental) Plan Medicare Part D Prescription Drug Plan (primary) Please note: Co-insurance is the percentage you pay out-of-pocket, toward your prescription when you go to the pharmacy. Co-payments would be a pre-established set amount that you pay toward each prescription. As a reminder, there are no co-payments under the DCMS plan. 7

8 Eligibility Requirements for Employer Group Wrap Plan Each retiree must have Medicare Parts A (hospitalization) and B (Physician services) Enrolled retirees and covered dependents must provide Dartmouth with their Medicare #, listed on their Medicare A and B card Retirees must provide a physical address not just a PO Box address Retirees must reside in the United States Must not be enrolled in another Medicare Part D plan (Annual Medicare Election Period Oct 15 Dec 7 th ) Effective dates for the plan are always first of the month January 1 st for each new plan year 1 st of your birth month if you are already retired but turning 65 1 st of the following month if you are newly retiring Dependents under age 65 - those who are not Medicare eligible will continue to be covered under the CVS Caremark plan 8

9 Medicare Part D Eligible If you are eligible for Medicare Part D, you will: Receive a new SilverScript ID card for prescription coverage Provide your pharmacist with your new SilverScript ID card after January 1, 2013 Pay the same *co-insurances as you are currently paying for prescription drugs under the Dartmouth College Medicare Supplement (DCMS) plan Fill up to a 90 day supply of your prescription at any of the 64,000 CVS & Non-CVS contracted pharmacies across the Nation. Have prescription coverage that is very close to the same as what you currently have under the CVS Caremark plan Continue to use your current participating pharmacy, or any of 64,000 network contracted pharmacies- it does not have to be CVS - To see if your pharmacy is in the network call toll-free at (866) Reminder: Under the DCMS plan format you will pay a 30% coinsurance toward the cost of your prescription until you have reached the annual $450 out-of-pocket maximum. Again, there are no co-payments under the DCMS plan. 9

10 Prescription fill limits Mail Order Pharmacy Retail Pharmacy Out-of-Network 2012 Beginning January 1, 2013 Up to a 90-day fill of your *covered prescription Up to a 90 day fill of your covered prescription Up to a 30 day fill of your covered prescription Up to a 90 fill of your covered prescription Up to a 90 day fill of your covered prescription Up to a 30 day fill of your covered prescription Submitted manually with a paper claim form. *Submitted manually with a paper claim form. * A covered prescription is a prescription listed on the CVS Caremark/SilverScript formulary list 10

11 What Do I Need To Do to remain on the Dartmouth plan? You will automatically be group-enrolled in the SilverScript prescription drug plan on the first of the month after you reach age 65, upon becoming eligible for Medicare, or if electing coverage during open enrollment Dartmouth and SilverScript will work together to enroll all the Medicare-eligible participants currently on the Dartmouth (DCMS) plan, into the SilverScript plan. Do not complete any Part D enrollment forms, interact with the Medicare program or take any other action to enroll in coverage through Medicare directly Do Not enroll in any Individual Medicare Prescription Drug Plans Do Not Opt Out of the Dartmouth plan As your new prescription drug plan, SilverScript is required to send you a letter giving you a chance to opt out or cancel your enrollment in the prescription drug plan. You will receive this opt out letter from SilverScript in late October. Please note: If you opt out, Medical and Prescriptions drug coverage for you and your dependents will terminate If you re-enroll you may be subject to a late enrollment penalty Make sure you provide Dartmouth with a physical address to avoid delayed enrollment and claims processing 11

12 Standard Mailings for Silver Script Part D Prescription Program Mailing Opt Out Letter Summary of Benefits Welcome Letter Evidence of Coverage Formulary Pharmacy Directory ID Cards Monthly Explanation of Benefits Coordination of Benefits Survey Description Do not Opt Out, Ignore letter Shows Co-insurance Structure Confirmation of Enrollment Complete details of Plan Abridged list of Covered Drugs Same as Current Network Individual ID card per member (EOB) Monthly breakdown of claims (COB) For other Coverage 12

13 The Affordable Care Act Part D- Adjustments: A small number of members may be eligible for Low Income Subsidy assistance (LIS): Look in your Medicare and You book to find more information on this assistance You would apply for LIS assistance through your Social Security Administration office There are four Levels of federal Low-Income Subsidy (LIS) Each level applies a specific premium (if any) and co-payment to the beneficiary A small number of members may incur an Income Related Monthly Adjusted Amount (IRMAA): Increased monthly premium based upon income reported to IRS Income limits for Part D mirror the income limits for Part B Dartmouth will reimburse those who substantiate the additional cost IRMAA is deducted automatically through social security or member is direct billed monthly or quarterly. Member must pay or they will lose coverage, works the same as Part B additional income premium, members can submit receipt of copy of invoice Notice of Medicare Premium Due 13

14 Low Income Subsidy (LIS) Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs If you qualify for Extra Help, you would be eligible for: Help paying your Medicare drug plan s monthly premium Yearly deductible Coinsurances and/or copays 2013 LIS Income Limits are usually set late September You will receive notice from CMS if you are eligible 14

15 Medicare Part D IRMAA Income Related Monthly Adjusted Amount Individual Tax Return Joint Tax Return Additional Amount $85,000 or below $170,000 or below $0.00 $85,001 - $107,000 $170,001 - $214,000 $11.60 $107,001 - $160,000 $214,001 - $320,000 $29.90 $160,001 - $214,000 $320,001 - $428,000 $48.10 Above $214,000 Above $428,000 $

16 Website built specifically for Dartmouth retiree members You will find quick Links to: CVS Caremark Mail Service Pharmacy Glossary & Acronyms Health and Wellness Mail Order Form Pharmacy Locator Temporary ID Card 2012 Medicare and You book (2013 will follow when it s published) Mail Service Pharmacy link will require a new log on ID and password 16

17 Health and Wellness Web Portal Through the dartmouth.silverscript.com website, you will have access to the Health and Wellness Web Portal Health-related information and tools Health risk assessment Health/lifestyle improvement programs Calculators/trackers and other tools to enable self assessment and program utilization Articles written about health and wellness for members of all ages with a focus on health issues for seniors 10 self-care centers that educate members on health-related topics for seniors Free to all SilverScript members Easily accessed through dartmouth.silverscript.com website Website will be available in the late fall before 1/1/

18 Bottom Line: What you need to know SilverScript Effective January 1, 2013, SilverScript (a subsidiary of CVS Caremark) will administer this EGWP +Wrap prescription drug plan for Dartmouth retirees and Medicare eligible Retiree Health Subsidy will be applied to your coverage as a household You will receive one invoice including coverage for both you and any of your covered dependents You will receive an OPT OUT letter from SilverScript as a Medicare required mailing. DO NOT OPT OUT if you want coverage through Dartmouth. You will receive a new SilverScript ID card per covered member Dartmouth s Open Enrollment period will run from October 22, 2013 thru November 5 th. You will receive open enrollment materials mid-october This presentation will be posted on the Retiree Health webpage, with a list of FAQ s 18

19 QUESTIONS?? 19

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