Page 39 - Pampa Benefit Guide 4-1-24
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Medicare Part D Notice: Prescription


           Drug Coverage and Medicare




        This  notice  has  information  about  your  current  prescription  drug   When  will  you  pay  a  higher  premium  (penalty)  to  join  a
        coverage with SkyBlue Healthcare  & your options  under  Medicare   Medicare Drug Plan?  You should also know that if you drop or
        prescription drug coverage.  This information can help you decide   lose  your  current  coverage  with  SkyBlue  Healthcare    medical
        whether or not you want to join a Medicare drug plan.  If you are   plan and don't join a  Medicare drug plan within 63 continuous
        considering  joining,  you  should  compare  your  current  coverage,   days after your current coverage ends, you may pay a higher
        including which drugs are covered at what cost, with the coverage   premium (a penalty) to join a Medicare drug plan later.  If you
        and costs of the plans offering Medicare prescription drug coverage   go 63 continuous days or longer without creditable prescription
        in  your  area.  Information  about  where  you  can  get  help  to  make   drug coverage, your monthly premium may go up by at least 1%
        decisions about your prescription drug coverage is at the end of this   of the Medicare base beneficiary premium per month for every
        notice.                                                   month that you did not have that  coverage.  For example, if
                                                                  you  go  nineteen  months  without  creditable  coverage,  your

        Please  note:   If  you  are  not  Medicare  eligible,  and  none  of  your
                                                                  premium  may  consistently  be  at  least  19%  higher  than  the
        covered family members are Medicare eligible, no action is required
                                                                  Medicare base beneficiary premium. You may have to pay this
        on your part.
                                                                  higher  premium  (a  penalty)  as  long  as  you  have  Medicare
        There  are  two  important  things  you  need  to  know  about  your      prescription drug coverage. In addition, you may have to wait
        current coverage and Medicare's prescription drug coverage:   until the following October to join.
        •    Medicare prescription drug coverage became available in 2006   For  more  information  about  this  notice  or  your  current
        to everyone with Medicare. You can get this coverage if you join a    Prescription  Drug  Coverage: Contact your HR department for
        Medicare Prescription Drug Plan or join a Medicare Advantage Plan   further  information.    NOTE:   You  may  receive  this  notice  at

        (like  an  HMO  or  PPO)  that  offers  prescription  drug  coverage.  All    other  times  in  the  future  such  as  before  the  next  period  you
        Medicare drug plans provide at least a standard level of coverage   can  enroll  in  Medicare prescription drug  coverage,  and  if  this
        set by Medicare.  Some plans may also offer more coverage for a   coverage changes.  You also may request a copy.
        higher monthly premium.
                                                                  For  more  information  about  your  options  under  Medicare
        •   SkyBlue Healthcare  has determined that the prescription drug   Prescription  Drug  Coverage: More detailed information about
        coverage offered by SkyBlue Healthcare  medical plan is, on average   Medicare plans that offer prescription drug coverage is in the
        for all plan participants, expected to pay out as much as standard         "Medicare & You" handbook.  You'll get a copy of the handbook
        Medicare prescription drug  coverage pays and is therefore  consid-  in  the  mail  every  year  from  Medicare.  You  may  also  be
        ered Creditable Coverage.  Because your existing coverage is Cred-  contacted directly by Medicare drug plans.
        itable Coverage, you can keep this coverage and not pay a  higher
                                                                  For  more  information  about  Medicare  prescription  drug
        premium (a penalty) if you later decide to join a Medicare drug plan.
                                                                  coverage:
        When can you join a Medicare Drug Plan? You can join a Medicare
                                                                  •   Visit www.medicare.gov.
        drug  plan  when  you  first  become  eligible  for  Medicare  and  each
        year from October 15 through December 7.  However, if you lose   •   Call your State Health Insurance Assistance Program (see the
        your current creditable prescription drug coverage, through no fault   inside  back  cover  of  your  copy  of  the  "Medicare  &  You"
        of your own, you will also be  eligible for a two (2) month Special         handbook for their telephone number) for personalized help.
        Enrollment Period (SEP) to join a Medicare drug plan.
                                                                  •  Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
        What  happens  to  your  current  coverage  if  you  decide  to  join  a    1-877-486-2048.
        Medicare  Drug  Plan?   If you decide to join a Medicare drug plan,

                                                                  If you have limited income and resources, extra help paying for
        your  current  SkyBlue  Healthcare    medical  coverage  will  not  be
                                                                  Medicare  prescription  drug  coverage  is  available.  For
        affected.  Participants  may  keep  this  coverage  if  they  elect  Part  D   information  about  this  extra  help,  visit  Social  Security  on  the
        and this plan will coordinate with Part D coverage. If you decide to   web at www.socialsecurity.gov, or call them at 1-800-772-1213
        join a  Medicare drug plan and drop your current SkyBlue Healthcare    (TTY  1-800-325-0778).
        medical plan coverage, be aware that you and your dependents will
        NOT be able to get this coverage back.

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