Page 27 - Revelations - Benefit Guide 2020 - Revised May 15

Medicare Part D Notice: Prescription

Drug Coverage and Medicare

This notice has information about your current prescription drug cover- affected. [See pages 9 - 11 of the CMS Disclosure of Creditable
age with Revelations Healthcare Group Beverage Group and your op- Coverage To Medicare Part D Eligible Individuals Guidance (available at
tions under Medicare's prescription drug coverage. This information http://www.cms.hhs.gov/CreditableCoverage/), which outlines the
can help you decide whether or not you want to join a Medicare drug prescription drug plan provisions/options that Medicare eligible
plan. If you are considering joining, you should compare your current individuals may have available to them when they become eligible for
coverage, including which drugs are covered at what cost, with the cov- Medicare Part D.]
erage and costs of the plans offering Medicare prescription drug cover-
age in your area. Information about where you can get help to make If you decide to join a Medicare drug plan and drop your current
decisions about your prescription drug coverage is at the end of this Revelations Healthcare Group medical plan coverage, be aware that
notice. you and your dependents will NOT be able to get this coverage back.
Please note: If you are not Medicare eligible, and none of your cov-
ered family members are Medicare eligible, no action is required on When will you pay a higher premium (penalty) to join a Medicare
your part. Drug Plan? You should also know that if you drop or lose your current
coverage with Revelations Healthcare Group’s medical plan and don't
There are Three important things you need to know about your cur- join a Medicare drug plan within 63 continuous days after your current
rent coverage and Medicare's prescription drug coverage: coverage ends, you may pay a higher premium (a penalty) to join a
Medicare drug plan later. If you go 63 continuous days or longer with-
1.Medicare prescription drug coverage became available in 2006 to out creditable prescription drug coverage, your monthly premium may
everyone with Medicare. You can get this coverage if you join a Med- go up by at least 1% of the Medicare base beneficiary premium per
icare Prescription Drug Plan or join a Medicare Advantage Plan (like month for every month that you did not have that coverage.
an HMO or PPO) that offers prescription drug coverage. All Medicare For example, if you go nineteen months without creditable coverage,
drug plans provide at least a standard level of coverage set by Medi- your premium may consistently be at least 19% higher than the Medi-
care. Some plans may also offer more coverage for a higher monthly care base beneficiary premium. You may have to pay this higher premi-
premium. um (a penalty) as long as you have Medicare prescription drug cover-
2.Revelations Healthcare Group has determined that the prescription age. In addition, you may have to wait until the following October to
drug coverage offered by the Revelations Healthcare Group is, on join.
average for all plan participants, NOT expected to pay out as much as
standard Medicare prescription drug coverage pays. Therefore, your For more information about this notice or your current Prescription
coverage is considered Non-Creditable Coverage. This is important Drug Coverage: Contact your HR department for further information.
because, most likely, you will get more help with your drug costs if NOTE: You may receive this notice at other times in the future such as
you join a Medicare drug plan, than if you only have prescription drug before the next period you can enroll in Medicare prescription drug
coverage from the [Insert Name of Plan]. This also is important be- coverage, and if this coverage changes. You also may request a copy.
cause it may mean that you may pay a higher premium (a penalty) if
you do not join a Medicare drug plan when you first become eligible. For more information about your options under Medicare Prescrip-
3.You can keep your current coverage from Revelations Healthcare tion Drug Coverage: More detailed information about Medicare plans
Group. However, because your coverage is non-creditable, you have that offer prescription drug coverage is in the "Medicare & You" hand-
decisions to make about Medicare prescription drug coverage that book. You'll get a copy of the handbook in the mail every year from
may affect how much you pay for that coverage, depending on if and Medicare. You may also be contacted directly by Medicare drug plans.
when you join a drug plan. When you make your decision, you should • Visit www.medicare.gov.
compare your current coverage, including what drugs are covered, • For personalized help, you can call 1-800-MEDICARE (1-800-633-
with the coverage and cost of the plans offering Medicare prescrip- 4227). TTY users should call 1-877-486-2048.
tion drug coverage in your area. Read this notice carefully it explains
your options. If you have limited income and resources, extra help paying for
Medicare prescription drug coverage is available. For information
When can you join a Medicare Drug Plan? You can join a Medicare drug about this extra help, please visit Social Security on the web at
plan when you first become eligible for Medicare and each year from www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-
October 15 through December 7. However, if you decide to drop your 325-0778).
current coverage, you will also be eligible for a two (2) month Special
Enrollment Period (SEP) to join a Medicare drug plan however you also
may pay a higher premium (a penalty) because you did not have credita-
ble coverage under Revelations Healthcare Group plan.

What happens to your current coverage if you decide to join a
Medicare Drug Plan? If you decide to join a Medicare drug plan, your
current Revelations Healthcare Group coverage will [or will not] be
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