HealthSelect Medicare Rx - prescription drugs program

HealthSelect Medicare Rx - prescription drugs program

UnitedHealthcare currently administers the Medicare retiree drug coverage.

You can call HealthSelect Medicare Rx Customer Service at UnitedHealthcare toll-free at (866) 868-0609 (TTY - 711), 7 a.m. – 7 p.m. CT, Monday – Friday, 7 a.m. – 3 p.m. CT on Saturday. 

With the enactment of the Medicare Modernization Act of 2003 (MMA), Medicare Part D was established to provide prescription drug coverage for Medicare beneficiaries. 

The Affordable Care Act of 2010 (ACA) includes important changes to the MMA. Generally, these changes improved Part D coverage by reducing the amounts beneficiaries were required to pay for various types of prescription drugs, increasing the value of an option known as an Employer Group Waiver Plan with a commercial wrap (EGWP + Wrap).

The GBP would provide standard Part D coverage through a self-funded EGWP and secondary coverage through a self-funded wrap-around (Wrap) arrangement. The Wrap would cover those prescription drugs that are not covered under Part D and would fill in the Part D coverage gap.

Together, the two components would closely match the prescription drug benefits currently provided under the GBP health plans. Under the EGWP + Wrap, the GBP would qualify for CMS subsidies and manufacturer discounts. These subsidies and discounts provide an opportunity for considerable savings that would help offset the need for drastic benefit cuts

Any Medicare-eligible participant enrolled in HealthSelect Secondary, HealthSelect Medicare Advantage or KelseyCare Advantage HMO is eligible for the coverage.

HMO participants-those in Scott & White, Community First and KelseyCare powered by Community Health Choice (KelseyCare powered by Community)-- will continue with their current prescription drug plan and are not enrolled in HealthSelect Medicare Rx.

Most retirees and dependents enrolled in the HealthSelect Medicare Rx plan will not need to pay an additional Medicare Part D premium. However, certain higher income Medicare beneficiaries enrolled in Part D coverage are subject to a payment amount referred to as the income-related monthly adjustment amount (IRMAA).

IRMAA applies to participants with an adjusted gross income of $85,000 or above (individuals and married individuals filing separately) or $170,000 or above (married individuals filing jointly). Participants with a higher income will pay extra for Medicare Part D coverage. ERS does not pay IRMAA premiums.

The Internal Revenue Service (IRS) provides the Social Security Administration (SSA) with the information necessary to determine whether a participant is subject to IRMAA. Contact Medicare toll-free at 800-MEDICARE (800-633-4227) if you have questions regarding the IRMAA payment.

No. Prescription coverage is only available in the United States and its territories.
Yes. The two plans will coordinate benefits. Typically, HealthSelect Medicare Rx will pay primary and TRICARE secondary.

Yes. You can use network retail pharmacies. You can find out if your pharmacy is in the network by using the Pharmacy Locator tool on the HealthSelect Medicare Rx website . With the locator tool, you can enter a ZIP code and a radius of miles to include in your search.

The plan has one mail service pharmacy, OptumRx® home delivery. You are not required to use OptumRx for a 90-day supply of your maintenance medications. Prescription orders sent directly to OptumRx from your doctor must have your approval before OptumRx can send your medications. This includes new prescriptions and prescription refills. OptumRx will contact you, by phone, to get your approval. At that time you may also tell OptumRx to automatically fill any future prescriptions they receive directly from your doctor(s) for up to one year. Contact UnitedHealthcare Customer Care if you have additional questions.

Yes. You still have access to an EDS network to purchase a 31 to 90 day supply of long-term medication at a retail pharmacy. Pharmacies include HEB, Kroger, Good Neighbor and many others.

Visit the HealthSelectSM Medicare Rx website for help finding an EDS network pharmacy.
Yes. However, if you are eligible for the HealthSelect Medicare Rx plan and decline coverage, you and any covered Medicare-eligible dependent will not have any prescription drug coverage in the Texas Employees Group Benefits Program (GBP).

If you're enrolled in the HealthSelect Medicare Advantage Plan, decline HealthSelect Medicare Rx coverage and enroll in a private Part D plan, you'll be disenrolled from your ERS Medicare Advantage Plan. However, if you enroll in a group Part D plan (perhaps through a spouse's employer coverage), you can keep your ERS Medicare Advantage Plan, but you won't have prescription coverage through the GBP.

If you decline enrollment in HealthSelect Medicare Rx, you can enroll later by contacting ERS. If you decide to enroll at a later date, your coverage won't become effective right away. You may be without prescription coverage for 29-60 days.

If you sign up for a private Part D plan, you'll be disenrolled from any ERS Medicare Advantage Plan. If you sign up for an alternate group Part D plan, you can keep your ERS Medicare Advantage Plan, but you won't have prescription coverage through the GBP.