Important Notice about Prescription Drug Coverage & Medicare
Medicare Part D plans are available to every person who is eligible for Medicare. All such plans will provide at least a standard level of coverage set by Medicare and some plans may offer more coverage for a higher monthly premium.
Note that the Medicare Part D prescription drug program is NOT a benefit provided through the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund (the “Trust”). It is provided through Medicare and is marketed by various Medicare-approved “Prescription Drug Providers” (PDPs).
If you are eligible for Medicare, you will have a chance to enroll in a Medicare-approved Part D plan from October 15th through December 7th of each year. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
Your September-October 2023 BENEFITS REPORT included the 2023 Certificate of Creditable Prescription Drug Coverage. That certificate reflects that your current prescription drug benefit program through the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund provides “creditable coverage.” It also includes answers to questions you may have regarding your current prescription drug program and how it relates to Medicare Part D coverage.
Be sure to read it carefully and keep it in a safe place where you can find it. If you enroll in one of the plans approved by Medicare which offer prescription drug coverage, you may need to give a copy of the notice when you join to show that you are not required to pay a higher premium. If you lose the notice and need another copy, please call the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund’s Administrator at (818) 243-0222, or request a copy in writing from PacFed Benefit Administrators, 1000 N. Central Ave., Ste. 400, Glendale, California 91202. Updated versions of the notice will be sent annually and you will be informed if the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund ever loses its creditable coverage status.
FAQs
Do I need to do anything now?
No, you can keep using the Trust’s prescription drug program the same as you always have. Your copayments will not change, nor will any pharmacy network.
When you first become eligible for Medicare*, you will have the option to independently enroll in a Medicare Part D prescription drug plan. However, by enrolling in a Part D plan you will permanently lose your current prescription drug coverage under the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund and you will not be reimbursed for your Part D premiums. As mentioned above, the standard Part D benefit is not as good as the Trust’s own prescription drug program (as described in your Trust plan booklet).
You should compare your current prescription drug program, including which drugs are covered, with the benefits and costs of the Medicare Part D plans available in your area. To view the official summary of approved Medicare Part D plans in any U.S. state, visit the Medicare site. Note that a Part D plan might not include your regular prescription drugs on its formulary. The Trust cannot provide you with a complete comparison of available Part D plans, but we urge you to carefully review any descriptions you may obtain.
So why do I need to keep my notice of creditable coverage?
In case you ever drop or lose your Trust coverage, or in the unlikely event that Trust coverage becomes non-creditable, having the notice will allow you to immediately enroll in a Part D plan without having to pay a late enrollment penalty. Specifically, if you try to enroll after your initial eligibility period, you will be charged a permanent Part D premium surcharge of 1% for every month since your initial Medicare eligibility for which you cannot show that you had creditable coverage (if such non-creditable period exceeds 62 days). Also note that you may have to wait for the next regular annual Part D enrollment period, which will be October 15th through December 7th for coverage in the following calendar year.
How can I get more information on Medicare Part D?
More detail will be in the handbook “Medicare & You” that will be mailed to you by Medicare in October of each year. You may also be contacted directly by Medicare-approved Part D providers. At any time you can visit the Medicare website or call (800) MEDICAR [(800) 633-4227]. TTY users should call (877) 486-2048.
Every state has a Health Insurance Assistance Program to help Medicare beneficiaries and their families with their health insurance choices and with problems that might arise. In California it is called the “Health Insurance Counseling and Advocacy Program” (HICAP) and can be reached (by non-cell phones only) at (800) 434-0222. Further assistance is available from the California Senior Information line (also by non-cell phones only) at (800) 510-2020. Contact information for similar programs in other states will be listed in your “Medicare & You” handbook.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. For more information about this extra help, visit the Social Security Administration website or call them at (800) 772-1213. TTY users should call (800) 325-0778.
Any questions? Call PacFed at (818) 243-0222.
*Your Medicare Initial Enrollment Period will be the month in which you become age 65, plus the preceding three months and the succeeding three months.