Page 29 - Citizens Bank Benefit Guide 2020_Revised 12-11-2020

Medicare Part D Notice: Prescription

Drug Coverage and Medicare

This otice has i formatio about your curre t prescriptio drug When will you pay a higher premium (penalty) to join a
coverage with Citize ’s Ba of Ada a d your optio s u der Medicare Drug Plan? You should also ow that if you drop or
Medicare's prescriptio drug coverage. This i formatio ca help lose your curre t coverage with Citize ’s Ba of Ada’s medical
you decide whether or ot you wa t to joi a Medicare drug pla . If pla a d do 't joi a Medicare drug pla withi 63 co ti uous
you are co sideri g joi i g, you should compare your curre t days after your curre t coverage e ds, you may pay a higher
coverage, i cludi g which drugs are covered at what cost, with the premium (a pe alty) to joi a Medicare drug pla later. If you
coverage a d costs of the pla s offeri g Medicare prescriptio drug go 63 co ti uous days or lo ger without creditable prescriptio
coverage i your area. I formatio about where you ca get help to drug coverage, your mo thly premium may go up by at least 1%
ma e decisio s about your prescriptio drug coverage is at the e d of the Medicare base be eficiary premium per mo th for every
of this otice. mo th that you did ot have that coverage. For example, if
you go i etee mo ths without creditable coverage, your

Please note: If you are ot Medicare eligible, a d o e of your
premium may co siste tly be at least 19% higher tha the
covered family members are Medicare eligible, o actio is required
Medicare base be eficiary premium. You may have to pay this
o your part.
higher premium (a pe alty) as lo g as you have Medicare
There are two important things you need to know about your prescriptio drug coverage. I additio , you may have to wait
current coverage and Medicare's prescription drug coverage: u til the followi g October to joi .
• Medicare prescriptio drug coverage became available i 2006 For more information about this notice or your current
to everyo e with Medicare. You ca get this coverage if you joi a Prescription Drug Coverage: Co tact Tracie Carter for further
Medicare Prescriptio Drug Pla or joi a Medicare Adva tage Pla i formatio , 580-310 4437. NOTE: You may receive this otice
(li e a HMO or PPO) that offers prescriptio drug coverage. All at other times i the future such as before the ext period you
Medicare drug pla s provide at least a sta dard level of coverage ca e roll i Medicare prescriptio drug coverage, a d if this
set by Medicare. Some pla s may also offer more coverage for a coverage cha ges. You also may request a copy.
higher mo thly premium.
For more information about your options under Medicare
• Citize ’s Ba of Ada has determi ed that the prescriptio drug Prescription Drug Coverage: More detailed i formatio about
coverage offered by Citize ’s medical pla is, o average for all pla Medicare pla s that offer prescriptio drug coverage is i the
participa ts, expected to pay out as much as sta dard Medicare "Medicare & You" ha dboo . You'll get a copy of the ha dboo
prescriptio drug coverage pays a d is therefore considered i the mail every year from Medicare. You may also be
Creditable Coverage. Because your existi g coverage is Creditable co tacted directly by Medicare drug pla s.
Coverage, you ca eep this coverage a d ot pay a higher premium
For more information about Medicare prescription drug
(a pe alty) if you later decide to joi a Medicare drug pla .
coverage:
When can you join a Medicare Drug Plan? You ca joi a Medicare
• Visit www.medicare.gov.
drug pla whe you first become eligible for Medicare a d each
year from October 15 through December 7. However, if you lose • Call your State Health I sura ce Assista ce Program (see the
your curre t creditable prescriptio drug coverage, through o fault i side bac cover of your copy of the "Medicare & You"
of your ow , you will also be eligible for a two (2) mo th Special ha dboo for their telepho e umber) for perso alized help.
E rollme t Period (SEP) to joi a Medicare drug pla .
• 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 joi a Medicare drug pla ,

If you have limited i come a d resources, extra help payi g for
your curre t Citize ’s Ba of Ada medical coverage will ot be
Medicare prescriptio drug coverage is available. For
affected. Participa ts may eep this coverage if they elect Part D
i formatio about this extra help, visit Social Security o the
a d this pla will coordi ate with Part D coverage. If you decide to web at www.socialsecurity.gov, or call them at 1-800-772-1213
joi a Medicare drug pla a d drop your curre t Citize ’s Ba of (TTY 1-800-325-0778).
Ada medical pla coverage, be aware that you a d your depe de ts
will NOT be able to get this coverage bac .

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