Medicare Prescription Drug Plans (Part D)

GENERAL QUESTIONS

Who is eligible for Medicare?

You’re eligible for Medicare if you are 65 or older, a U.S. citizen or permanent resident, and if Medicare taxes were taken out of your or your spouse’s paycheck for at least 10 years. If you’re under 65, you could still qualify for Medicare if you have a disability or permanent kidney failure.

You can use the Eligibility & Premium Calculator at Medicare.gov to answer questions about your Medicare eligibility and enrollment period. Check out these resources for more information about Medicare eligibility:

• Medicare & You – Click Find Out More under Download Medicare & You. Medicare & You is available in multiple formats.

• Social Security Medicare Benefits – Click the Publications link for Medicare resources in English and Spanish PDF and audio formats.

Source: Medicare.gov

Do I really need a prescription drug plan?

The answer depends on your medical and financial situation. Think about your needs and what's important to you. Keep in mind the costs of prescriptions are high and expected to increase. A prescription drug plan may help control your expenses. Remember, if you were eligible to join Medicare Part D and did not do so, you may have to pay a penalty for joining the plan later and that penalty increases with each month you do not enroll.

What are the dates for enrollment in Medicare plans?

Here are key enrollment dates: October 15 – December 7, 2013 (Annual Election Period) If you're eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan, for the following year. During this period, you can also change plans or enroll in a separate prescription drug plan.

What is the Special Enrollment Period?

If you didn’t sign up for Medicare when you first became eligible, then you may qualify for the Special Enrollment Period if you lost your job or your group health coverage — or your spouse did. If that’s the case, then you have eight months after your group coverage ends to sign up for both parts A and B. For more information, please contact our Medicare Department at:

Toll Free: 1-877-484-2411 (TTY:711)

Local Number: 1-671-646-6956 ext. 7228/7509

Source: Medicare.gov

I will be turning 65 in a few months. When can I enroll in TakeCare’s Prescription Drug Plan?

You may enroll anytime during the first three months immediately preceding the month your enrollment in Medicare Parts A and B becomes effective. This time is called your Initial Coverage Election Period. It generally coincides with the month you turn 65 years old; however, some people choose to delay Part B coverage for a while if they have other coverage through their employer. In that case, it would be the month that your Part B coverage goes into effect, assuming you already have Part A.

What is a Medicare Prescription Drug (Part D) plan?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

Does TakeCare prescription drug plan make sense for someone who takes only a few prescriptions each month?

Most people with Medicare currently need, or will come to need, prescription drugs to stay healthy. So, even if you don't need many prescription drugs now, choosing a prescription drug plan today can protect you from high out-of-pocket costs later. Also, if you don't sign up for drug coverage when you're first eligible but decide to enroll later, you may have to pay more each month - at least 1 percent more for every month you wait.

What is a Medicare Late Enrollment Penalty (LEP)?

A late enrollment penalty (LEP) is a monthly premium penalty calculated and assessed by the Centers for Medicare & Medicaid Services (CMS).

If you do not enroll in a Medicare prescription drug plan (PDP) by the end of your Medicare Initial Enrollment Period (IEP) for Part D and do not have creditable prescription drug coverage for any continuous period 63 days or longer, you may have to pay an LEP.

You may choose to continue your drug coverage in another plan and not enroll in a Medicare Part D plan without an LEP if the other coverage is at least as good as the Medicare drug benefit.

How can I avoid a Medicare Late Enrollment Penalty (LEP)?

You can avoid a late enrollment penalty (LEP) by:

• Enrolling in a Medicare prescription drug plan (PDP) before the end of your Medicare Initial Enrollment Period (IEP) for Part D

• Continuing your drug coverage in another plan with coverage that is at least as good as the Medicare drug benefit

Other LEP exceptions may include:

• Members with a low income subsidy (LIS)

• Members affected by Hurricane Katrina

• Members receiving assistance from a state pharmaceutical assistance program (SPAP)

What is credible coverage?

Creditable coverage is prescription drug coverage that is at least as good as the Medicare drug benefit.

Prescription drug coverage is insurance. Prescription drug coverage is not drug samples, discount cards, free clinics or drug discount websites. A Health Insurance Portability & Accountability Act (HIPAA) Portability Creditable Coverage statement is not proof that prescription drug coverage is as good as Medicare’s drug benefit.

How do I send proof of credible coverage?

These documents are accepted proof of creditable coverage:

• Completed attestation of creditable coverage form

• Copy of a personalized disclosure notice from a previous insurance carrier

• Copy of a generic creditable coverage disclosure notice from a previous insurance carrier and a copy of either an ID card with effective dates or a recent monthly premium statement

Proof of creditable coverage must be submitted to TakeCare within 21–30 days from the date on the creditable coverage letter.

Note: Prescription drug coverage is insurance. Prescription drug coverage is not drug samples, discount cards, free clinics or drug discount websites. A Health Insurance Portability & Accountability Act (HIPAA) creditable coverage statement is not proof that prescription drug coverage is as good as Medicare’s drug benefit.

You can submit your proof of credible coverage by:

Mail

TakeCare Medicare Department

P.O. Box 6578

Tamuning Guam 96931

Fax

1 (671) 647-3547

Can I enroll in a Medicare prescription drug plan if I have a Medicare Supplement Plan?

Yes, but if the Medicare Supplement policy covers prescription drugs, the drug coverage must be removed from the Medicare Supplement policy. TakeCare's Medicare Supplement insurance plans do not come with drug coverage, so you can enroll in one of TakeCare's prescription drug plans and TakeCare's Medicare Supplement insurance plans.

I’m helping someone enroll. What option should I pick on the Enrollee Information page?

The online enrollment form will ask who is completing the application. If you have Power of Attorney, select the second option.

Note:If a Power of Attorney is enrolling someone for our prescription drug plans, the POA must cover the ability to make healthcare decisions and is usually referred to as a "Durable Power of Attorney for Healthcare" or "Healthcare Power of Attorney." If a Power of Attorney is enrolling someone for our Medicare Supplement Plans, the POA must cover the ability to make insurance decisions and is usually referred to as a "Durable Power of Attorney" or "Power of Attorney."

ENROLLMENT QUESTIONS

How do I enroll in a Medicare Prescription Drug Plan?

Enrolling in TakeCare Rx Plus, TakeCare’s Approved Medicare Prescription Drug Plan, is easy. You may enroll online, by phone, or by mail.

• Enroll Online

Our online enrollment is fast, safe, and handy - and it's easy:

Click on "Enroll Now" in the top right corner of this page or Click Here

• Enroll by Phone

To enroll by phone, you can call toll free at 1-877-484-2411 (TTY 711), 24 hours a day, local time, 7 days a week and speak to a customer service representative.

• Enroll by Mail

To enroll by mail, download, fill out and print and enrollment form that is available online at www.takecarerxplus.com in the “resources” section.

Can I enroll in a prescription drug plan, if I have Medicare Parts A and B?

If you're entitled to Part A and/or enrolled in Part B of Medicare, you're eligible to join a prescription drug plan.

What information do I need to have ready before I enroll in a Medicare plan?

Have your red, white and blue Medicare ID card available when you enroll. If you don’t have your red, white and blue Medicare ID card available, contact the Social Security Administration (SSA) at 1-800-772-1213 or 1-800-325-0778 (TTY). Ask the SSA for your name that appears in their records and your Medicare Part A and B effective dates.

Before you start your enrollment, make sure you have this information:

• ZIP code

• Medicare number

• Last name

• Date of birth

If you plan has a premium, you may want to have your bank account or credit card number.

If I enroll online, is my information safe and secure?

Yes. At TakeCare we take the safety and privacy of members and prospective members very seriously. To make sure all the information on your enrollment form remains private and confidential, we protect this Website with Comodo Secure. Comodo Secure is a trusted, nationally known company that ensures all transactions sent through our site are completely secure. No one else can see or use any data you share with us. Confirm the security of this site here.Confirm the security of this site here.

Can I save my information and come back to complete it later?

No. If you choose to exit before you submit your enrollment form, your answers will not be saved.

I’m having trouble completing the online enrollment form. Who should I call?

No problem! Just call our Medicare Department at:

Toll Free Number: 1-877-484-2411 (TTY:711)

Local Number: 1-671-647-3526 ext. 7228/7509

How can I be sure TakeCare received by online enrollment?

After the Centers for Medicare & Medicaid Services (CMS) approves your Medicare prescription drug plan enrollment, TakeCare sends a letter confirming your coverage.

I am enrolling at the end of the month. Will my coverage begin immediately?

In general, your coverage is effective on the first day of the month after we receive your completed application – unless you request a later effective date or you enrolled prior to your Medicare Part A or B dates. However, it can take some time for Medicare and TakeCare to process your application, so be sure to keep temporary proof of membership with you until you receive your TakeCare Member ID card.

POST ENROLLMENT QUESTIONS

How do I pay my premiums?

In addition to the monthly Medicare Part B premium to Medicare, you pay a premium to the insurance company that provides your coverage. TakeCare offers several ways to pay, including automatic bank account withdrawal or credit card. You also have the option of a coupon book.

When does the Medicare prescription drug coverage begin?

If you sign up for a prescription drug plan during the annual election period - October 15 through December 7 - your coverage begins on January 1 of the following year. If you sign up outside of the annual election period, your coverage begins on the first day of the month after Humana receives your completed application - unless you request a later effective date.

When will I get my TakeCare Medicare Prescription Drug Member ID Card?

You will receive your ID card 7 to 10 days from the time of completed enrollment.

If I need coverage before my Member ID card arrives, what should I do?

If you need to see a doctor or fill a prescription after your coverage begins but before you receive your ID card, use a copy of your temporary proof of membership. Temporary proof of membership could be a letter of coverage. You should receive your letter of coverage 7-10 days after receipt of your enrollment form.

BENEFIT QUESTIONS

How much will my TakeCare prescription drug plan cost?

Currently, the monthly premium for TakeCare Rx Plus, a Medicare approved prescription drug plan, is $52.70.

Note: You may have to pay more than the plan’s premium if your income is above a certain amount. Each year, Social Security will notify you if you have to pay more. This additional amount will be deducted from your social security check.

What is the TakeCare prescription drug benefit?

Medicare contracts with insurance companies, including TakeCare, to offer prescription drug plans (PDPs). If you're considering a PDP, please keep the following in mind:

Optional plan. A PDP is an option - not a requirement. However, if you don't join a PDP when you become eligible, you may have to pay a higher premium if you join later.
Monthly premium. PDPs have a monthly premium in addition to any Medicare premium you already pay.
Benefits and costs. PDP plan benefits vary, but companies offering these plans are required to offer certain minimum benefits. TakeCare's PDP benefits are equal to, or better than, these required minimums.

Can a friend or family member talk to TakeCare about my benefits?

Yes, but first you'll need to send TakeCare a consent form. Once TakeCare has approved it, your caregiver can talk to a Customer Care specialist during a medical emergency, to get help filing or checking up on a claim, or to find out if a treatment is covered. To get more information and download the consent form, go to Resources - Give another person permission to help manage your care.

Where can I find a Medicare consent form?

Go to “Resources” page to download the Release of Personal Health Information Form.

What prescription drug plans does TakeCare offer?

TakeCare offers one stand-alone prescription drug plan, called TakeCare Rx Plus.

Can my membership with TakeCare’s Prescription Drug Plans be cancelled by the plan?

TakeCare can't cancel your coverage because of your age or health. You may be involuntarily disenrolled from the plan only under the following circumstances:

1. You permanently move out of the service area and fail to notify us. (A permanent move includes an absence of more than six consecutive months.)

2. Your Medicare Part A or Medicare Part B coverage ceases.

3. You knowingly commit fraud or permit misuse of your membership card.

4. You are disruptive, unruly, abusive, or uncooperative for reasons unrelated to your medical condition and your behavior prevents treatment to you or other members (disenrollment for cause). We must receive prior approval from CMS for this type of disenrollment.

5. Our contract with CMS is terminated or the service area is reduced.

6. You fail to pay any monthly plan premium.

When can I change my Medicare plan?

You can change your Medicare plan during the Annual Election Period (AEP) or Special Enrollment Period (SEP).

Do I need to sign up for Medicare prescription drug coverage?

The answer depends on your medical and financial situation. Think about your needs and what's important to you. The costs of prescriptions continue to increase, so a prescription drug plan may help control your costs. Remember, if you were eligible to join Medicare Part D by May 15, 2006, and did not do so, you will have to pay a penalty for joining the plan later and that penalty increases each month.

How do I find my current drug costs?

What’s the difference between Medicare Parts A and B and Medicare prescription coverage?

Medicare covers hospital costs under Part A and medical costs like doctor's office visits under Part B. Medicare Part D provides benefits for prescription drugs obtained at a pharmacy – a growing part of many peoples' healthcare budgets.

Prescription drug plan coverage differs from Medicare in two ways: (1) It is available only through private insurance companies like TakeCare and (2) you should use in-network pharmacies, to take full advantage of your coverage.

Are both brand-name and generic drugs covered under TakeCare’s plans?

Yes, but not all brand-name and generic drugs are covered. You should verify that your drugs are part of TakeCare's approved Drug List before enrolling in one of our plans. The complete drug list is available online at www.takecarerxplus.com.

Your costs for generic drugs are usually lower than your costs for brand-name drugs. The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity, and stability as brand-name drugs.

How can I find out which drugs are covered?

TakeCare's Medicare Prescription Drug List (formulary) can show you which drugs are covered with each plan. The drug list can be found at www.takecarerxplus.com.

What is a formulary?

A formulary is a list of prescription medications approved for coverage by a health plan.

How often does the drug list change?

TakeCare updates the Drug List at least once a year, at the beginning of the year. However, medications on the Drug List can be added, changed, or deleted from the list at any time. For instance, we may move a brand-name drug to a different category when a generic equivalent becomes available.

What if a medication I’m already taking is not offered on the Drug list?

TakeCare will cover a one-time, temporary supply of your current drug. After that:

• If the Drug List includes other drugs that treat the same condition, TakeCare requires you to try those drugs before we cover the drug you already take. For example, if Drug A and Drug B both treat your medical condition, TakeCare may not cover drug B unless you try Drug A first. If Drug A does not work for you, TakeCare will cover Drug B. This process is called "Step Therapy."

• If no other options are available on the Drug List, your doctor must obtain approval from TakeCare before we cover the prescription. This process is called "Prior Authorization."

Are insulin and diabetic supplies covered by TakeCare’s prescription drug plans?

Insulin is covered under TakeCare’s prescription drug plan, as well as certain supplies used to inject the Insulin, such as syringes, needles and alcohol swabs. Diabetic self-monitoring supplies - including glucose monitors, test strips, lancets, and screening tests - are covered under Medicare's medical benefits rather than prescription drug benefits.

I have coverage through Veterans Affairs (VA). Will my prescriptions continue to be covered?

As long as you still qualify for TRICARE, Veterans Affairs (VA), or the Federal Employee Health Benefits (FEHB) Program, your drug coverage did not change with the introduction of the Medicare Part D plan. Contact your benefits administrator or your FEHB insurer before making any changes to your coverage. It will almost always be to your advantage to keep your current coverage without any changes.

If you lose your TRICARE, VA, or FEHB coverage and join a Medicare Part D plan, in most cases you won't have to pay a penalty as long as you join within 63 days of losing TRICARE, VA, or FEHB coverage.

What are generic drugs?

Generic drugs are almost the same as brand-name drugs. They have the same active ingredients — the chemical substances that treat or prevent an illness or health condition. They’re also used for the same condition or illness, come in the same strength, and have identical dosage recommendations. They are also held to the same safety standards. So how are generic drugs different? Their inactive ingredients — like flavorings, colors, and preservatives — are usually different from brand-name drugs.

Source: FDA

Are brand-name drugs made in more modern factories that generic drugs?

No. Both brand-name and generic drug factories must meet the same standards of manufacturing. The U.S. Food and Drug Administration (FDA) conducts about 3,500 inspections a year to guarantee that companies meet these high standards. In fact, brand-name firms are linked to an estimated 50 percent of all generic drugs. They frequently make copies of their own or other brand-name drugs, and sell them under a generic or store-name label.

Source: FDA

Are generic drugs as safe and strong as brand-name drugs?

Yes. The U.S. Food and Drug Administration (FDA) requires that all drugs be safe and effective. Generics use the same active ingredients and are shown to work the same way to cure, treat, or prevent your illness or health condition. So they have the same quality, strength, and purity as their brand-name counterparts.

Source: FDA

Are the non-active ingredients in generic medicines as good as those in brand-name drugs?

Yes, the U.S. Food and Drug Administration (FDA) must approve every ingredient (including inert, or non-active, ones) that goes into medicine. Sometimes a generic manufacturer must change one or more of these non-active ingredients — which include flavoring, color, and preservatives — because the brand-name company has patented the preparation of the specific drug. Changing the inert ingredients doesn’t affect the effectiveness of the drug, since the generic manufacturer must show the FDA that the active ingredient — the one that treats or prevents your disease or health condition — still gets into your body at the same strength and rate as the brand-name drug.

Source: Generic Pharmaceutical Association

Does every brand-name drug have a generic counterpart?

No. The government gives a company the exclusive right to make and sell a drug for a set time period (usually 20 years after the company filed a patent for the drug). That way, the original manufacturer can gain back the money it spent to research, develop, and market the drug. When the patent expires, other companies can make and sell a generic version. But they can only do this after the generic drug has been thoroughly tested by the manufacturer and approved by the U.S. Food and Drug Administration (FDA).

Source: FDA

Do generic drugs take longer to work in the body?

No. According to the U.S. Food and Drug Administration (FDA), generic drugs are made to work in the same way and in the same amount of time as brand-name drugs.

Source: FDA

Why are generic drugs less expensive?

Generic drugs are usually 30% to 75% less expensive because the companies spend much less on research and advertising costs than brand-name drug companies do. That means they can pass these lower costs on to you. Plus, once generic drugs receive approval from the U.S. Food and Drug Administration (FDA), there is greater competition, which also keeps the price down. Today, almost half of all prescriptions are filled with generic drugs, according to the FDA.

Source: FDA

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