Download "Annual Notice of Changes for 2015"
2 Prescription Blue PDP, Option B Annual Notice of Changes for Think about Your Medicare Coverage for Next Year Each fall, Medicare allows you to change your Medicare health and drug coverage during the Annual Enrollment Period. It s important to review your coverage now to make sure it will meet your needs next year. Important things to do: Check the changes to our benefits and costs to see if they affect you. It is important to review benefit and cost changes to make sure they will work for you next year. Look in Section 2 for information about benefit and cost changes for our plan. Check the changes to our prescription drug coverage to see if they affect you. Will your drugs be covered? Are they in a different tier? Can you continue to use the same pharmacies? It is important to review the changes to make sure our drug coverage will work for you next year. Look in Section 2 for information about changes to our drug coverage. Think about your overall health care costs. How much will you spend out-ofpocket for the services and prescription drugs you use regularly? How much will you spend on your premium? How do the total costs compare to other Medicare coverage options? Think about whether you are happy with our plan. If you decide to stay with Prescription Blue Option B If you want to stay with us next year, it s easy - you don t need to do anything. If you don t make a change by December 7, you will automatically stay enrolled in our plan. If you decide to change plans: If you decide other coverage will better meet your needs, you can switch plans between October 15 and December 7. If you enroll in a new plan, your new coverage will begin on January 1, Look in Section 3.2 to learn more about your choices.
5 Prescription Blue PDP, Option B Annual Notice of Changes for Cost 2014 (this year) 2015 (next year) Part D prescription drug coverage (See Section 2.3 for details.) Drug Tier 4: Nonpreferred brand You pay a $85 copay for a one-month, (31-day) supply of drugs from a preferred or non-preferred You pay a $ copay You pay a $255 copay for or non-preferred Drug Tier 5: Specialty You pay a 33% coinsurance for a onemonth (31-day) supply from a preferred or nonpreferred Once your total drugs costs have reached $2,850, you will move to the Coverage Gap Stage). Drug Tier 4: Nonpreferred brand You pay a $90 copay for a one-month, (31-day) supply of drugs from a standard or preferred retail You pay a $225 copay for retail You pay a $270 copay for supply from a standard retail Drug Tier 5: Specialty You pay a 33% coinsurance for a onemonth (31-day) supply from a standard or preferred retail Once your total drugs costs have reached $2,960, you will move to the Coverage Gap Stage.
8 Prescription Blue (PDP) Option B Annual Notice of Changes for We included a copy of our Pharmacy Directory in the envelope with this booklet. An updated Pharmacy Directory is located on our website at You may also call Member Services for updated provider information or to ask us to mail you a Pharmacy Directory. Please review the 2015 Pharmacy Directory to see which pharmacies are in our network. Section 2.3 Changes to Part D Prescription Drug Coverage Changes to basic rules for the plan s Part D drug coverage Effective June 1, 2015, before your drugs can be covered under the Part D benefit, CMS will require your doctors and other prescribers to either accept Medicare or to file documentation with CMS showing that they are qualified to write prescriptions. Changes to Our Drug List Our list of covered drugs is called a Formulary or Drug List. A copy of our Drug List is in this envelope. We made changes to our Drug List, including changes to the drugs we cover and changes to the restrictions that apply to our coverage for certain drugs. Review the Drug List to make sure your drugs will be covered next year and to see if there will be any restrictions If you are affected by a change in drug coverage you can: Work with your doctor (or other prescriber) and ask the plan to make an exception to cover the drug. Current members can ask for an exception before next year and we will give you an answer within 72 hours after we receive your request (or your prescriber s supporting statement). If we approve your request, you ll be able to get your drug at the start of the new plan year. o To learn what you must do to ask for an exception, see Chapter 7 of your Evidence of Coverage (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)) or call Member Services. Find a different drug that we cover. You can call Member Services to ask for a list of covered drugs that treat the same medical condition. In some situations, we will cover a one-time, temporary supply. (To learn more about when you can get a temporary supply and how to ask for one, see Chapter 3, Section 5.2 of the Evidence of Coverage.) During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.
9 Prescription Blue (PDP) Option B Annual Notice of Changes for Changes to Prescription Drug Costs Note: If you are in a program that helps pay for your drugs ( Extra Help ), the information about costs for Part D prescription drugs may not apply to you. We have included a separate insert, called the Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs (also called the Low Income Subsidy Rider or the LIS Rider ), which tells you about your drug coverage. If you get Extra Help and didn t receive this insert with this packet please call Member Services and ask for the LIS Rider. Phone numbers for Member Services are in Section 7.1 of this booklet. There are four drug payment stages. How much you pay for a Part D drug depends on which drug payment stage you are in. (You can look in Chapter 4, Section 2 of your Evidence of Coverage for more information about the stages.) The information below shows the changes for next year to the first two stages the Yearly Deductible Stage and the Initial Coverage Stage. (Most members do not reach the other two stages the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs in these stages, look at Chapter 4, Sections 6 and 7, in the enclosed Evidence of Coverage. Changes to the Deductible Stage Stage 2014 (this year) 2015 (next year) Stage 1: Yearly Deductible Stage Because we have no deductible, this payment stage does not apply to you. Because we have no deductible, this payment stage does not apply to you.
12 Prescription Blue (PDP) Option B Annual Notice of Changes for Stage 2014 (this year) 2015 (next year) Drug Tier 5: Specialty You pay a 33% coinsurance for a onemonth (31-day) supply from a preferred or nonpreferred Once your total drugs costs have reached $2,850, you will move to the Coverage Gap Stage). Drug Tier 5: Specialty You pay a 33% coinsurance for a onemonth (31-day) supply from a standard or preferred retail Once your total drugs costs have reached $2,960, you will move to the Coverage Gap Stage. Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages the Coverage Gap Stage and the Catastrophic Coverage Stage are for people with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, look at Chapter 4, Sections 6 and 7, in your Evidence of Coverage.
16 Prescription Blue (PDP) Option B Annual Notice of Changes for coverage gap or late enrollment penalty. Many people are eligible and don t even know it. To see if you qualify, call: o MEDICARE ( ). TTY users should call , 24 hours a day/7 days a week; o The Social Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, (applications); or o Your State Medicaid Office (applications). Prescription Cost-sharing Assistance for Persons with HIV/AIDS The AIDS Drug Assistance Program (ADAP) helps ensure that ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medications. Individuals must meet certain criteria, including proof of State residence and HIV status, low income as defined by the State, and uninsured/under-insured status. Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance through the Michigan HIV/AIDS Drug Assistance Program (MIDAP). For information on eligibility criteria, covered drugs, or how to enroll in the program, please call SECTION 8 Questions? Section 8.1 Getting Help from Prescription Blue Option B Questions? We re here to help. Please call Member Services at (TTY only, call 711.) We are available for phone calls 8:00 a.m. to 8:00 p.m. seven days a week. Calls to these numbers are free. Read your 2015 Evidence of Coverage (it has details about next year's benefits and costs) This Annual Notice of Changes gives you a summary of changes in your benefits and costs for For details, look in the 2015 Evidence of Coverage for Prescription Blue (PDP) Option B. The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered services and prescription drugs. A copy of the Evidence of Coverage was included in this envelope. Visit our Website You can also visit our website at bcbsm.com/medicare. As a reminder, our website has the most up-to-date information about our pharmacy network (Pharmacy Directory) and our list of covered drugs (Formulary/Drug List).