Medicare Prescription Drug Program

What is the Medicare Prescription Drug Coverage?

Medicare prescription drug coverage is insurance provided by private companies that have been approved by Medicare. Medicare prescription drug coverage is available to everyone with Medicare. This drug coverage may help lower prescription drug costs and help protect against higher costs in the future.

If you chose to join a Medicare prescription drug plan, you will have to pay a monthly premium. All drug plans must provided coverage that is at least as good as standard Medicare prescription drug coverage. Some plans might offer more coverage and additional drugs for higher monthly premiums.

You can get more information about the Medicare prescription drug program at www.medicare.gov or you can call 1.800.MEDICARE (1.800.633.4227).

If you have limited income and resources, you may qualify for extra help. Most people who qualify for this extra help will pay no premiums, no deductibles and no more than $5 for each prescription. The amount of extra help depends on your income and resources. For more information about extra help, contact the Social Security Administration (SSA) online at www.socialsecurity.gov or call SSA at 1.800.772.1213.

I already have prescription drug coverage under my current FEHB health insurance plan. What should I do?

The US Office of Personnel Management (OPM), as are all employers or unions that offer prescription drug coverage, are required to send you information about how your Service Benefit Plan coverage for prescription drugs compares with the Medicare standard prescription drug coverage. This notice is in the inside cover of the Blue Cross and Blue Shield Service Benefit Plan brochure. Please read this notice. It is also a standard part of all brochures for FEHB carriers.

OPM determined that your Service Benefit Plan prescription drug coverage is, on average, expected to pay out as much as the standard Medicare Part D prescription drug coverage will pay for all plan participants and is considered Creditable Coverage. Thus you do not need to enroll in Medicare Part D and pay extra for prescription drug benefit coverage. As long as you keep your Service Benefit Plan coverage or other FEHB coverage that is as good as the standard Medicare prescription drug plan, you will not pay a penalty if you decide to enroll in Medicare Part D prescription drug coverage later.

However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage and your FEHB plan will coordinate benefits with Medicare. Remember, if you are an annuitant and cancel your FEHB coverage, you cannot re-enroll.

If I decide to get Medicare Part D prescription drug coverage, how will it affect my prescription drug benefits?

If you have both Service Benefit Plan and Medicare Part D coverage, the Service Benefit Plan and Medicare will coordinate benefits for covered prescription drug changes. If we are the primary payer, we will provide benefits for your covered prescription drug charges first. If Medicare Part D pays first, we will review your claims for prescription drug costs that are not covered by Medicare Part D and consider them for payment.

For more information about who is primary, see the Primary Payer Chart in Section 9 of the Service Benefit Plan brochure.

Information coordinated by Paula Spurway, Blue Cross and Blue Shield Association.

Updated October 2007.