Page 35 - Pump Down Specialist FINAL Benefit Guide 9-1-2024

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

Please note: If you are not Medicare eligible, and none of your
coverage, your premium may consistently be at least 19% high-
covered family members are Medicare eligible, no action is required
er than the Medicare base beneficiary premium. You may have
on your part.
to pay this higher premium (a penalty) as long as you have
There are two important things you need to know about your Medicare prescription drug coverage. In addition, you may
current coverage and Medicare's prescription drug coverage: have to wait 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, 903-947-2490 NOTE: You may receive this
(like an HMO or PPO) that offers prescription drug coverage. All notice at other times in the future such as before the next peri-
Medicare drug plans provide at least a standard level of coverage od you can enroll in Medicare prescription drug coverage, and if
set by Medicare. Some plans may also offer more coverage for a this coverage changes. You also may request a copy.
higher monthly premium.
For more information about your options under Medicare
• Pump Down Specialist, LLC has determined that the prescription Prescription Drug Coverage: More detailed information about
drug coverage offered by Pump Down Specialist, LLC medical plan is, Medicare plans that offer prescription drug coverage is in the
on average for all plan participants, expected to pay out as much as "Medicare & You" handbook. You'll get a copy of the handbook
standard Medicare prescription drug coverage pays and is there- in the mail every year from Medicare. You may also be
fore considered Creditable Coverage. Because your existing contacted directly by Medicare drug plans.
coverage is Creditable Coverage, you can keep this coverage and not
For more information about Medicare prescription drug
pay a higher premium (a penalty) if you later decide to join a Medi-
coverage:
care drug plan.
• Visit www.medicare.gov.
When can you join a Medicare Drug Plan? You can join a Medicare
drug plan when you first become eligible for Medicare and each • Call your State Health Insurance Assistance Program (see the
year from October 15 through December 7. However, if you lose inside back cover of your copy of the "Medicare & You"
your current creditable prescription drug coverage, through no fault handbook for their telephone number) for personalized help.
of your own, you will also be eligible for a two (2) month Special
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
Enrollment Period (SEP) to join a Medicare drug plan.
1-877-486-2048.
What happens to your current coverage if you decide to join a
If you have limited income and resources, extra help paying for

Medicare Drug Plan? If you decide to join a Medicare drug plan,
Medicare prescription drug coverage is available. For
your current Pump Down Specialist, LLC medical coverage will not information about this extra help, visit Social Security on the
be affected. Participants may keep this coverage if they elect Part D web at www.socialsecurity.gov, or call them at 1-800-772-1213
and this plan will coordinate with Part D coverage. If you decide to (TTY 1-800-325-0778).
join a Medicare drug plan and drop your current Pump Down Spe-
cialist, LLC medical plan coverage, be aware that you and your de-
pendents will NOT be able to get this coverage back.
35