The Sidney Hillman Health Center prescription drug benefit is considered Non-Creditable Coverage.

Medicare requires that the Sidney Hillman Health Center send you a notice every year concerning your prescription drug benefits under Medicare Part D.  We have not made any change in our Prescription Benefit program for 2009.  If you are satisfied with your 2008 Medicare D coverage, you may not need to take any action at this time.  However, please take the time to review any changes made by your insurance company to your 2009 coverage.  If you wish to change your Medicare Part D coverage or if you do not have Medicare Part D coverage, please read this notice carefully. 

Please read this notice carefully and keep it where you can find it.  This notice has information about your current prescription drug benefit with Sidney Hillman Health Center and prescription drug coverage available for people with Medicare.  It also explains the options you have under Medicare prescription drug coverage, and can help you make enrollment decisions.  At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage.

• Medicare prescription drug coverage became available to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage in 2006. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 

• Sidney Hillman Health Center has determined that the prescription drug benefit it offers is, on average for all plan participants, NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Non-Creditable Coverage.  This is important, because for most people eligible for Sidney Hillman Health Center benefits, enrolling in Medicare prescription drug coverage means you will get more assistance with drug costs than if you had prescription drug coverage exclusively through Sidney Hillman Health Center’s Benefit Plan.

• You have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you enroll.  Read this notice carefully - it explains your options. 
  

Consider enrolling in a Medicare Prescription Plan

Because the prescription drug benefit you have with the Sidney Hillman Health Center is on average for all plan participants, NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay, consider enrolling in a Medicare prescription drug plan.  Individual’s can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st.  Beneficiary’s leaving employer coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan.

You should also know if you drop or lose your coverage through your employer and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

If you go 63 days or longer without prescription drug coverage that is at least as good as Medicare’s prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. Example, if you go nineteen months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium.  You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage.  In addition, you may have to wait until the following November to join.

A recent change in New York State law requires EPIC seniors to enroll in a Medicare Part D drug plan as a condition of eligibility.  EPIC will provide Part D premium assistance to all enrollees so that no one will be disadvantaged by this new requirement.  Although EPIC may be creditable coverage, they strongly urge you to consider joining a Medicare Drug Plan, if you have not done so already. If you are satisfied with your current plan, you do not need to do anything.

EPIC will send you a letter regarding reducing your annual deductible amount to help offset the cost of your monthly Part D premiums.  If you pay a fee to EPIC, they will let you know the amount they’ll pay towards your monthly Part D premium.  This amount will be paid directly to your insurance company.

IF YOU ARE CURRENTLY PAYING AN ANNUAL FEE TO EPIC AND BEING REIMBURSED BY THE HEALTH CENTER:  There will be no change.   The Health Center will continue to repay you the cost of the EPIC fee.

If you have the EPIC  deductible plan and are not covered by a drug benefit from your former employer, you will need to enroll in a Medicare Part D plan.

YOU MAY BE ELIGIBLE FOR A REDUCED PREMIUM if your annual income and available assets are less than 150% of the federal poverty guidelines.  This will normally only apply to members who pay a fee to EPIC for coverage.  You should have received an application from Social Security.   Please fill out and return the application to Social Security to qualify for additional benefits.

IF YOU ARE COVERED FOR PRESCRIPTION DRUG COVERAGE THROUGH YOUR FORMER EMPLOYER: You will receive information from your current insurance carrier as to whether this coverage is as good as Medicare Part D (this is called “creditable” coverage).  If your former employer offers creditable Medicare Part D coverage, you must enroll in that coverage in order to be eligible for Health Center pharmacy benefits.

Without other coverage, Health Center benefits, on average for all members, are NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay.

IF YOU HAVE NOT SIGNED UP FOR ANY MEDICARE PART D PLAN, YOU WILL BE CHARGED THE WHOLESALE PRICE FOR YOUR PRESCRIPTIONS AT THE HEALTH CENTER.

If You Wish to Change your Medicare Part D Plan or if You Do Not Have Medicare Part D Coverage Now, You Need to Make a Decision.

When you make your decision, you should also compare your current coverage (including which drugs are covered) with the coverage and cost of other plans offering Medicare prescription drug coverage in your area.

NOTE:  You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if coverage through Sidney Hillman Health Center changes. 

For more information about your options under Medicare prescription drug coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook from Medicare.  You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare-approved prescription drug plans.  For more information about Medicare prescription drug plans:

• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help,
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available.  For information about this extra help, visit Social Security Administration (SSA) on the web at www.socialsecurity.gov, or you call them at 1-800-772-1213 (TTY 1-800-325-0778).

                                         Date:               October 13, 2008
                                     Sender:               Sidney Hillman Health Center of Rochester
                                   Address:               750 East Avenue, Rochester, New York 14607
                     Phone Number:               585-473-2000