Department of Employee Trust Funds - Hot Topic
July 28, 2005 (Updated 10/03/2005)

Questions from STATE participants covered under the State’s Group Health Insurance Program

What is Medicare Part D?

It is a new prescription drug benefit program administered by the federal government. Enrollment in Medicare Part D coverage begins November 15, 2005, for coverage effective January 1, 2006.

I have prescription drug coverage through the state’s group health insurance program. Should I enroll in a Medicare Part D prescription drug plan when I become eligible?

State retirees: Keep in mind you are already paying for and receiving comprehensive prescription drug coverage through the state’s group health insurance program. Your current drug coverage, administered through Navitus Health Solutions, is creditable coverage in comparison to the Medicare Part D prescription drug benefit. This coverage will allow you to defer enrollment in Part D without penalty. Nevertheless, you should carefully consider all options before making any kind of enrollment decision. Participation in Medicare Part D is voluntary and in 2006 you will pay a monthly premium of about $38. If you would like to maintain your current level of prescription drug benefits under our program, it is not necessary to enroll in Medicare Part D at this time.

Will my State health insurance premium go down if I enroll in a Medicare Part D prescription drug plan?

No. Your health insurance premium includes both medical and prescription drug coverage and is already reduced to account for the Medicare drug subsidy. If you enroll in a Medicare prescription drug plan, you will continue to pay the same premium in addition to paying the Part D premium (approximately $38/month) to Medicare. Navitus will coordinate coverage with Medicare and pay after Medicare processes your prescription claims, minus the applicable copayments and coinsurance that are your responsibility.

Where can I get more information about how my State employee program pharmacy benefits would be affected if I enroll in the Medicare Part D program?

The Department of Employee Trust Funds will communicate with you in several ways. Information will be available in the 2006 It’s Your Choice booklet, in the September edition of the It’s Your Benefit Newsletter, and on the Department’s Internet site. The Department also plans to mail letters to retirees in September explaining how pharmacy benefits are affected by Medicare Part D.

I am covered under the Wisconsin Public Employers (WPE) Program. How does Medicare Part D affect my prescription drug coverage? Should I enroll in a Part D Prescription Drug Plan?

Yes, you should enroll in the Group Insurance Board’s preferred Medicare Prescription Drug Plan (PDP), Dean Health Insurance, Inc. (DHI). Your premium already includes the cost of Medicare Part D coverage through DHI. Information about how to enroll will be sent to you by DHI. Navitus will work directly with DHI to ensure that your Medicare Part D benefits are coordinated with your coverage under this plan. If you choose to enroll in a PDP other than DHI, you will not receive a reduction in premium, and you may experience additional expenses as Navitus will only coordinate benefits as though you were enrolled in DHI. If you do not enroll in a Part D PDP, your prescription drug claims will be paid as though you had Medicare Part D coverage. This means that you will be responsible for the portion of your claims that DHI would have paid, hence more out of pocket costs for you. In all cases, you will be responsible for the prescription drug copayments outlined in Uniform Benefits.

Other resources for you include the following:

Navitus Customer Service
Phone toll free: 1-866-333-2757
Regular Hours: 7 a.m. - 9 p.m. CST, Monday through Friday
Holiday Hours: 8:30 a.m. - 5p.m. CST, (Closed Thanksgiving and Christmas Day)

Department of Employee Trust Funds
Phone toll free: 1-877-533-5020
Local Madison: (608) 266-3285

Prescription Drug Helpline
Phone toll free: 1-866-456-8211, Monday through Friday

Medigap Helpline
Phone toll free: 1-800-242-1060 (leave a message)

Wisconsin Coalition for Advocacy
Information and resources for Medicare beneficiaries who receive disability benefits
Phone toll free: 1-800-926-4862, Monday through Friday

Wisconsin Benefits Specialists Program
To locate your benefits specialist, contact your County Aging Unit or the Department of Health and Family Services-Bureau of Long Term Care Resources
Phone: (608) 266-2536; TTY: (608) 267-9880.

Center for Medicare and Medicaid Services Fact Sheet

Medicare D Letter Sent to Annuitants September 28, 2005

Wisconsin Medicare D Resource Center