TRB and Medicare Prescription Drug Creditable Coverage
Is my current coverage through the TRB’s prescription plan equivalent to or better than the Medicare Part D prescription coverage?
Yes. The TRB prescription drug coverage offered to you is “on average” expected to pay out at least as much as the standard Medicare prescription drug coverage. Because your existing TRB coverage is “on average” as good as standard Medicare Part D prescription coverage, you can stay with your TRB coverage. If you decide later you want to enroll in Medicare Part D prescription coverage and drop the TRB plan, you will NOT incur a penalty to your Medicare Part D premium PROVIDED there is no lapse in prescription coverage.
What are the consequences if I choose to enroll in the Medicare Part D prescription coverage?
You will remain in your TRB health coverage but will be dropped from your TRB prescription coverage. There will be no reduction or refund to your TRB premium. You would only be allowed back into the TRB prescription coverage during the next open enrollment period, provided you submit evidence that you have cancelled your Medicare Part D prescription coverage.
How will I decide whether to remain in the TRB prescription plan or choose Medicare Part D prescription coverage?
Medicare Part D prescription coverage is different from the health coverage available under Medicare Parts A and B. To obtain prescription coverage under Medicare Part D, you will have to choose a plan from a private company. While there is standard coverage required by Medicare Part D prescription coverage, each private plan is likely to have unique attributes, including which drugs are covered, the level of co pays, and which pharmacies you can use. Accordingly, you should compare your current coverage and cost with the coverage and cost of the plans offering Medicare Part D prescription drug coverage in your area.
The basic components of the TRB prescription plan:
TRB Prescription Plan
- Deductible: $250 per year.
- Mail Order: Co-Insurance: Individual pays 5% of the cost for generic drugs, 20% of the cost for preferred drugs, and 30% of the cost for non-preferred drugs. Local Pharmacy: Co-Insurance (non-maintenance drugs): Individual pays 10% of the cost for generic drugs, 25% of the cost for preferred drugs, and 35% of the cost for non-preferred drugs.
- Coverage Gap: None.
- Catastrophic Coverage: After the individual pays $1,000 (including the deductible of $250) out of pocket, individual pays nothing for the remainder of the year.
For individuals who use generic drugs, the TRB coverage will generally be less costly to the individual. For non-preferred drugs, the relative costs will depend on the volume low volume users of non-preferred drugs may have a lower cost under Medicare Part D, whereas those with high volume users will often pay more under Medicare Part D. If you enroll in Medicare Part D prescription coverage, you will lose access to your TRB prescription plan and will still be required to pay the full premium for the health and prescription plans.
Is there a penalty if my TRB coverage lapses and I enroll in the new Medicare Part D Plan late?
Yes. If you drop or lose your coverage with TRB and do not enroll within 63 days in a Medicare prescription drug plan, you will be subject to a permanent lifetime penalty of at least 1% per month for every month you did not have prescription coverage. For example, if you are without prescription coverage for nineteen months, your premium will always be at least 19% higher than normal cost for the Medicare prescription plan.
How can I get more information about my options under Medicare prescription drug coverage?
More detailed information about Medicare plans that offer prescription drug coverage is available now in the "Medicare & You" handbook. http://www.medicare.gov or Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.