HealthSelect Medicare Rx - prescription drugs program

HealthSelect Medicare Rx - prescription drugs program

UnitedHealthcare currently administers the HealthSelect Medicare Rx prescription drug coverage.

You can call HealthSelect Medicare Rx Customer Service 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. 

Medicare Rx is an EGWP+Wrap plan. EGWP+Wrap stands for Employer Group Waiver Plan with a commercial wrap. EGWP+Wrap plans are intended to help fill coverage gaps in Medicare Part D and provide retirees with prescription drug benefits comparable to the HealthSelect of Texas Prescription Drug Program. 

Additionally, the EGWP + Wrap qualifies ERS for subsidies and manufacturer discounts from the Centers for Medicare & Medicaid Services. These subsidies and discounts provide savings that help offset the need to reduce benefits.
Participants enrolled in HealthSelect Secondary, HealthSelect Medicare Advantage or KelseyCare Advantage HMO who also are enrolled in Medicare Part A or Part B (or both) are eligible for HealthSelect Medicare Rx. You must live in the HealthSelect service area.

Participants in Scott & White Health Plan or Community First Health Plans 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, participants with an income that is higher than the threshold set by Medicare will pay extra for Medicare Part D coverage. This is the income-related monthly adjustment amount, or IRMAA. ERS does not pay IRMAA premiums.

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). 
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.

Yes. The mail service pharmacy is OptumRx® home delivery. You are not required to use OptumRx for a 90-day supply of your maintenance medications. You must approve prescription orders sent directly to OptumRx from your provider 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 give OptumRx approval to automatically fill any future prescriptions they receive from your provider(s) for up to one year.

Contact UnitedHealthcare Customer Care if you have questions. 

Yes. You can use a retail pharmacy from the EDS network to purchase a 31- to 90- day supply of long-term medication. Pharmacies on the EDS list include HEB, Kroger, Good Neighbor and many others. 

View the EDS list of participating pharmacies or visit the HealthSelectSM Medicare Rx website. 
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 are 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 later, your coverage will not 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.