If I have CRDP, why should I enroll in Part D?
CRDP drug coverage is not creditable coverage. This means that if a CRDP carholder waits to enroll in a Part D plan, they may have to pay a late penalty unless they have creditable coverage through another source. Enrolling in Part D may help reduce out-of-pocket costs for medications not currently covered by CRDP. It also helps the CRDP save money that can be used to expand benefits in the future.
Can I decide not to enroll in Part D at all?
Yes, the CRDP is voluntary. If you are in CRDP and you choose not to enroll in Part D, CRDP will continue to pay for your drugs as it has in the past. However, if you decide to enroll in Part D later, you may be assessed a higher monthly premium because CRDP is not considered "creditable coverage."
Did all CRDP cardholders get selected for Part D?
No. CRDP enrolled cardholders into Part D if they were eligible for Part D coverage and had not yet enrolled in Part D on their own. Cardholders who have creditable coverage through an employer or retiree plan or who are enrolled in a Medicare Advantage plan (Medicare HMO) should not have been enrolled by CRDP into a stand-alone Part D plan. If you are a CRDP cardholder whose enrollment into a Part D plan negatively affected any other healthcare coverage that you have, please contact the program at 1-800-225-7223.
How do I know if CRDP is enrolling me in Medicare Part D?
If CRDP enrolls you into a Part D plan, you will receive a letter from the program telling you the name of the Medicare Part D plan that they have selected for you. If you did not receive a letter, you would not have been auto-enrolled into a Part D plan by the CRDP.
If you are enrolled in a Medicare Advantage plan (HMO) or have creditable coverage through your employer-sponsored retiree plan, CRDP will not enroll you into a stand-alone Part D plan.
If we enrolled you in Part D it would disrupt your health insurance or cause you to lose coverage completely. If you have either of these coverages, you should contact your insurance company for further instructions on whether you should enroll in Part D.
I have not received any letter or other information from CRDP about how they will work with my Part D plan. Does that mean that I will not get any help from CRDP with Part D costs?
CRDP will attempt to help all CRDP members with their Part D plan costs during the deductible and the doughnut hole phases. In addition to this assistance, the CRDP is able to help individuals who are enrolled in CRDP partner plans and the partner plans' Medicare Advantage plans by assisting with premium payments.
The CRDP is currently trying to get agreements with all Part D plans in order to assist with premium payments for all cardholders. Ultimately, CRDP may not be able to help cardholders with Part D costs if their Part D plan does not want to work with CRDP.
If you are enrolled in a part D plan that is not a CRDP partner plan, then CRDP will provide coverage during any deductible or doughnut hole phases and payment for co-payment differences between the plan and CRDP. However, CRDP is not able to provide premium payments unless a premium payment agreement has been made between the non-partner plan and the Commonwealth.
If you would like to switch to a CRDP partner plan in order to get the most help with your Part D costs, you can contact the program at 1-800-225-7223.
I had already joined a Part D plan on my own. Will the CRDP help me with the costs of that coverage?
The CRDP intends to help all members with the costs of Part D coverage; however, the timeframe for when this help begins will differ depending on what Part D plan you currently have. And, ultimately, some Part D plans may not agree to work with CRDP.
When did CRDP start working with Part D?
CRDP began working with Part D effective October 1, 2006, therefore, you can use your Part D identification card along with your CRDP card at the pharmacy, and the program would help you with Part D costs so that you do not have to pay more under Part D than you would under CRDP.
How will pharmacies know about these changes?
CRDP staff has informed pharmacies about how the CRDP works with Part D. We continue to share information with the pharmacies on a regular basis.
I am not currently enrolled in CRDP. If I enroll in the program, will I be automatically enrolled in Part D?
If you are enrolled in a Part D plan when you enroll in CRDP, you can stay enrolled in the Part D plan. If it is not a CRDP partner plan, we may not be able to help with all the Part D costs.
If you are not enrolled in Part D when you enroll in CRDP, we will not assign you to a Part D plan immediately but will provide recommendations to you within a few months. CRDP is a state pharmaceutical assistance program (SPAP). As an SPAP, CRDP has two enrollment periods for Medicare Part D - an annual enrollment period and a special enrollment period.
Who will pay the Part D premium?
The CRDP Program will pay the Part D premiums for CRDP cardholders up to the regional benchmark, which is $35.50 in 2014. However, in order for this to occur, the CRDP must execute agreements with the Part D plans. If you are enrolled in a plan that is not a partner plan (see below), and an agreement has not been made with the non-partner plan, then, CRDP will not be able to pay your premiums.
If I am enrolled in Part D, will I still use my CRDP Card?
Yes, show both cards at the pharmacy. This will tell your pharmacist to bill your Part D plan first, and bill CRDP second. It will also tell your pharmacist that you are entitled to all of the drugs that are available under CRDP.
Will my co-payments be higher with CRDP and Medicare Part D?
No, not for medications that are covered by CRDP. If your Part D plan charges higher co-pays than you were paying under CRDP, the CRDP program will pay the difference if the pharmacy has the capability to bill more than one payer for a prescription claim. If you are taking medications that are not covered by the CRDP, you will pay your part D plan's co-pay for those drugs. If there is any confusion at your pharmacy, call the program's toll free number at 1-800-225-7223 while you are at the pharmacy.
Suppose my Part D plan charges lower co-payments than CRDP. What happens?
You will pay the lower co-payments.
Many Part D plans stop their coverage after you reach a certain dollar limit. This is sometimes called the doughnut hole. How does this work under Medicare Plus CRDP?
The CRDP will fill in gaps, so that you can continue to get your drugs just as you did under CRDP. However, if you are taking medications that are not covered by CRDP, then you will be responsible for the full cost of the medication that is charged to you by your Part D plan during the doughnut hole period, unless you have other prescription benefits that can be used during this time.
Suppose my Part D plan does not cover all of the drugs that CRDP covers?
The CRDP program will automatically pay for drugs that your Part D plan won't cover, so long as these are drugs covered by CRDP.
Can I go to any pharmacy I choose if I am in CRDP and Medicare Part D?
No, you must use the pharmacies that are in your Part D plan's network. We picked a plan for you that included the pharmacy where you usually get your prescriptions filled. If you decide to change pharmacies, check with your new pharmacy to make sure they participate in your Part D plan.
If my Part D plan offers a mail-order service, can I use it?
Yes, but the mail-order pharmacy must participate with CRDP in order for the program to help pay for your extra copayments. Also, since you will be ordering a three-month supply of your drug by mail, you will be paying up to three CRDP copayments at once. For example, a CRDP cardholder would pay $18 for a 90-day supply of generic medications.
Where can I get a list of the mail-order pharmacies that I can use?
CRDP cardholders enrolled in Part D use the pharmacies that participate in the Part D plan's pharmacy network. If your Part D plan offers mail-order services, the plan has information for you regarding these pharmacies in their Welcome Kit and enrollment documents.
How did the program decide which Part D plan to enroll me in?
We looked at the drugs that you take that are covered by the CRDP and tried to match you up with a partner Part D plan that covers those medications. We also checked to make sure that your pharmacy participates in that plan.
Which Part D plans have partnered with CRDP? What are the premiums for each plan?
2014 Partner Plans
2014 Monthly Premiums
Cigna Medicare Rx Plan One
Silverscript Basic Plan
WellCare Classic Plan
Are these the only plans that I can enroll in?
No, but these plans have signed agreements with the program and that makes it easier for CRDP to coordinate with them and avoid confusion. Enrolling in a partner plan guarantees that you get the most help with your Part D plan costs.
Where can I get more information about the Part D plans available in PA?
Information about premiums, participating pharmacies and covered drugs for Part D plans operating in Pennsylvania is available by calling 1-800-Medicare (1-800-633-4227 or 1-877-486-2048 (TTY)) or on the web at: www.medicare.gov
Can I pick a different plan from the one that the program has chosen for me?
Yes. During the Open Enrollment Period, anyone on Medicare can change their Part D plan. The program will send you information about your options. If you would like to pick a different partner plan, you should call 1-800-225-7223. If you want to enroll in a Part D plan that is not one of our partner plans, you should call Medicare at 1-800-633-4227.
If I am already enrolled in a Part D plan and have been paying my monthly premiums to the plan, will I still be switched over to the Part D plan that the CRDP program picked for me?
During the Open Enrollment Period, you will receive a letter from the program if you are already enrolled in Part D giving you the opportunity to switch to a partner plan. The choice is yours, and you are not required to change plans.
What should I do if I receive a bill from my Part D plan for the monthly premium?
If you are enrolled in one of CRDP's partner plans, the CRDP will pay up to the regional benchmark and you should not received a bill from the Part D plan. If you receive a bill from your Part D plan, you should contact the Program at 1-800-225-7223.
If I am in a Medicare Advantage plan without prescription drug coverage, do I have to change plans to enroll in Part D?
If you are in a Medicare Advantage Plan without prescription drug coverage and you would like to enroll in Part D, you need to contact your Medicare Advantage Plan to see if they offer a Part D benefit. If they do, you should enroll through your Medicare Advantage plan in order to keep your doctor and other health care providers. If you are in CRDP, the program will pay the Part D premium portion for you as long as the plan has signed a premium payment agreement with the CRDP.
If your Medicare Advantage Plan does not offer a Part D benefit, then you may need to join a different Medicare Advantage Plan through a different company to get Part D. Keep in mind that changing Medicare Advantage plans may affect your choice of doctors.