Are there any other costs associated with this coverage?
Retiree currently being reimbursed for Medicare B premiums by the SHBP will also be reimbursed for any Medicare Part D premiums. However, retirees who are not eligible for Medicare B & D reimbursement, who earn more than $91,000 per year ($182,000 if married and filing jointly) will have a deduction from their Social Security benefit for Medicare Part D as follows:
| YOU PAY IN 2022 | IF YOUR YEARLY INCOME IN 2020 WAS | |
|---|---|---|
| Part D | Single | Married Couple |
| Your Plan Premium* | $91,000 or less | $182,000 or Less |
| $12.40 + Your Plan Premium | $91,001 - $114,000 | $182,001 - $228,000 |
| $32.10 + Your Plan Premium | $114,001 - $142,000 | $228,001 – $284,000 |
| $51.70 + Your Plan Premium | $142,001 – $170,000 | $284,001 - $340,000 |
| $71.30 + Your Plan Premium | $170,001 – $500,000 | $340,001 - $750,000 |
| $77.90 + Your Plan Premium | $500,001 and Above | $750,001 and Above |
How will my prescription coverage change if I decide not to enroll in Medicare Part D?
Retired members, and/or dependents, who do not enroll in the OptumRx Medicare Prescription Drug Plan but enroll in a privately offered Medicare Part D plan will lose their SHBP prescription drug coverage. In addition, the SHBP will not cover the costs of any drugs that are not covered by the Medicare Part D plan. Retirees should carefully review plan options if comparing Medicare D plans.
Will my copayments change?
The OptumRx Medicare Prescription Drug Plan provides “wrap-around” coverage that eliminates the “coverage gap” also known as the “donut hole.” Members will continue to pay the appropriate copayment for prescription drugs.
Do I need to do anything because of the change?
No. The State Health Benefits Program (SHBP) and OptumRx will automatically enroll eligible retirees into Medicare Part D and the new OptumRx Medicare Prescription Drug Plan (PDP).
How can I receive additional information about the plan?
You may contact the OptumRx Medicare Prescription Drug Plan (1-844-368-8740).
How does this affect my coverage under Medicare Part A and/or Part B?
OptumRx Medicare is a Medicare prescription drug plan and is in addition to your coverage under Medicare Part A and/or Part B. Your enrollment in the plan does not affect your coverage under Medicare Part A and/or Part B. All retirees belonging to the SHBP who are eligible for Medicare must enroll in and maintain both Medicare Part A (Hospital) and Part B (Medical) coverage.
It is your responsibility to inform OptumRx of any prescription drug coverage that you have or may get in the future.
May I continue to use my current pharmacy?
Yes, if your pharmacy currently accepts the OptumRx plan from the SHBP, you will be able to continue using that pharmacy with the OptumRx Medicare prescription program. However, if your pharmacy does not accept Medicare Part D plans, you may elect a participating pharmacy in order to use the SHBP prescription drug benefits through OptumRx Medicare Prescription Drug Plan. You may locate a participating using the OptumRx Pharmacy locator.
What changes are being made to retiree prescription drug coverage?
Retirees and dependent spouses and/or partners who are eligible for Medicare will be automatically enrolled in OptumRx Medicare Prescription Drug Plan (PDP) which is a Medicare Part D Prescription Drug Plan.