Annual Notice of Changes for 2017

Transcription

1 WeCare Cassic (PDP) offered by WeCare Prescription Insurance, Inc. Annua Notice of Changes for 2017 You are currenty enroed as a member of WeCare Simpe (PDP). Next year, there wi be some changes to the pan s costs and benefits. This booket tes about the changes. You have from October 15 unti December 7 to make changes to your Medicare coverage for next year. Additiona Resources This information is avaiabe for free in other anguages. Pease contact our Customer Service number at for additiona information. (TTY users shoud ca ). Hours are Monday-Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are avaiabe Monday-Sunday, 8 a.m. to 8 p.m. Customer Service aso has free anguage interpreter services avaiabe for non-engish speakers. Esta información está disponibe gratis en otros idiomas. Por favor comuníquese con nuestro número de Servicio a Ciente a para información adiciona. (Los usuarios de TTY deben amar a ) E horario es de unes a viernes de 8 a.m. a 8 p.m. Entre e 1 de Octubre y e 14 de Febrero, os representantes están disponibes de unes a domingo de 8 a.m. a 8 p.m. E Servicio a Ciente también tiene servicios gratis de intérpretes a otros idiomas para as personas que no haban ingés. This booket is aso avaiabe in different formats, incuding arge print, audio compact disc (CD), and Braie. Pease ca Customer Service if S4802_NA034528_PDP_CMB_ENG CMS Accepted OMB Approva Form CMS ANOC/EOC (Approved 03/2014) NA7CLACMB75166E_0616

2 WeCare Cassic (PDP) Annua Notice of Changes for you need pan information in another format (phone numbers are printed on the back cover of this booket). About WeCare Cassic (PDP) WeCare (PDP) is a Medicare-approved Part D Sponsor. Enroment in WeCare (PDP) depends on contract renewa. When this booket says we, us, or our, it means WeCare Prescription Insurance, Inc. When it says pan or our pan, it means WeCare Cassic (PDP). Think about Your Medicare Coverage for Next Year Each fa, Medicare aows you to change your Medicare heath and drug coverage during the Annua Enroment Period. It s important to review your coverage now to make sure it wi meet your needs next year. Important things to do: o o o o Check the changes to our benefits and costs to see if they affect you. It is important to review benefit and cost changes to make sure they wi work for you next year. Look in Sections 2.1 and 2.3 for information about benefit and cost changes for our pan. Check the changes to our prescription drug coverage to see if they affect you. Wi your drugs be covered? Are they in a different tier? Can you continue to use the same pharmacies? It is important to review the changes to make sure our drug coverage wi work for you next year. Look in Section 2 for information about changes to our drug coverage. Think about your overa heath care costs. How much wi you spend out-of-pocket for the services and prescription drugs you use reguary? How much wi you spend on your premium? How do the tota costs compare to other Medicare coverage options? Think about whether you are happy with our pan. If you decide to stay with WeCare Cassic (PDP):

3 WeCare Cassic (PDP) Annua Notice of Changes for If you want to stay with us next year, it s easy - you don t need to do anything. If you decide to change pans: If you decide other coverage wi better meet your needs, you can switch pans between October 15 and December 7. If you enro in a new pan, your new coverage wi begin on January 1, Look in Section 4.2 to earn more about your choices. Summary of Important Costs for 2017 The tabe beow compares the 2016 costs and 2017 costs for WeCare Cassic (PDP) in severa important areas. Pease note this is ony a summary of changes. It is important to read the rest of this Annua Notice of Changes and review the encosed Evidence of Coverage to see if other benefit or cost changes affect you.

4 WeCare Cassic (PDP) Annua Notice of Changes for Cost 2016 (this year) 2017 (next year) Monthy pan premium* *Your premium may be higher or ower than this amount. See Section 2.1 for detais. $26.80 $24.90 Part D prescription drug coverage (See Section 2.3 for detais.) Deductibe: $360 Copayment/Coinsurance during the Initia Coverage Stage: Drug Tier 1: $0.00 Drug Tier 2: $8.00 Drug Tier 3: $47.00 Drug Tier 4: 50% Drug Tier 5: 25% Deductibe: $400 on Tiers 2 to 5 Copayment/Coinsurance during the Initia Coverage Stage: Drug Tier 1: $0.00 Drug Tier 2: $20.00 Drug Tier 3: $47.00 Drug Tier 4: 50% Drug Tier 5: 25%

5 WeCare Cassic (PDP) Annua Notice of Changes for Annua Notice of Changes for 2017 Tabe of Contents Think about Your Medicare Coverage for Next Year... 2 Summary of Important Costs for SECTION 1 Uness You Choose Another Pan, You Wi Be Automaticay Enroed in WeCare Cassic (PDP) in SECTION 2 Changes to Benefits and Costs for Next Year... Section 2.1 Changes to the Monthy Premium Section 2.2 Changes to the Pharmacy Network... 7 Section 2.3 Changes to Part D Prescription Drug Coverage... SECTION 3 Other Changes... SECTION 4 Deciding Which Pan to Choose Section 4.1 If You Want to Stay in WeCare Cassic (PDP) Section 4.2 If You Want to Change Pans SECTION 5 Deadine for Changing Pans SECTION 6 Programs That Offer Free Counseing about Medicare... SECTION 7 Programs That Hep Pay for Prescription Drugs SECTION 8 Questions? Section 8.1 Getting Hep from WeCare Cassic (PDP) Section 8.2 Getting Hep from Medicare... 16

6 WeCare Cassic (PDP) Annua Notice of Changes for SECTION 1 Uness You Choose Another Pan, You Wi Be Automaticay Enroed in WeCare Cassic (PDP) in 2017 On January 1, 2017, WeCare Prescription Insurance, Inc. wi be combining WeCare Simpe (PDP) with one of our pans, WeCare Cassic (PDP). If you do nothing to change your Medicare coverage by December 7, 2016, we wi automaticay enro you in our WeCare Cassic (PDP). This means starting January 1, 2017, you wi be getting your prescription drug coverage through WeCare Cassic (PDP). If you want to, you can change to a different Medicare prescription drug pan. You can aso switch to a Medicare heath pan. If you want to change, you must do so between October 15 and December 7. The information in this document tes you about the differences between your current benefits in WeCare Simpe (PDP) and the benefits you wi have on January 1, 2017 as a member of WeCare Cassic (PDP). SECTION 2 Changes to Benefits and Costs for Next Year Section 2.1 Changes to the Monthy Premium Cost 2016 (this year) 2017 (next year) Monthy premium (You must aso continue to pay your Medicare Part B premium uness it is paid for you by Medicaid.) $26.80 $24.90 Your monthy pan premium wi be more if you are required to pay a ifetime Part D ate enroment penaty for going without other drug coverage that is at east as good as Medicare drug

7 WeCare Cassic (PDP) Annua Notice of Changes for coverage (aso referred to as creditabe coverage ) for 63 days or more. If you have a higher income, you may have to pay an additiona amount each month directy to the government for your Medicare prescription drug coverage. Your monthy premium wi be ess if you are receiving Extra Hep with your prescription drug costs. Section 2.2 Changes to the Pharmacy Network Amounts you pay for your prescription drugs may depend on which pharmacy you use. Medicare drug pans have a network of pharmacies. In most cases, your prescriptions are covered ony if they are fied at one of our network pharmacies. Our network incudes a mai service pharmacy with preferred cost-sharing, which may offer you ower cost- sharing than the standard cost-sharing offered by other pharmacies within the network. There are changes to our network of pharmacies for next year. An updated Pharmacy Directory is ocated on our website at You may aso ca Customer Service for updated provider information or to ask us to mai you a Pharmacy Directory. Pease review the 2017 Pharmacy Directory to see which pharmacies are in our network. Section 2.3 Changes to Part D Prescription Drug Coverage Changes to Our Drug List Our ist of covered drugs is caed a Formuary or Drug List. A copy of our Drug List is in this enveope. We made changes to our Drug List, incuding changes to the drugs we cover and changes to the restrictions that appy to our coverage for certain drugs. Review the Drug List to make sure your drugs wi be covered next year and to see if there wi be any restrictions. If you are affected by a change in drug coverage you can: Work with your doctor (or other prescriber) and ask the pan to make an exception to cover the drug. We encourage current members to ask for an exception before next year.

8 WeCare Cassic (PDP) Annua Notice of Changes for To earn what you must do to ask for an exception, see Chapter 7 of your Evidence of Coverage (What to do if you have a probem or compaint (coverage decisions, appeas, compaints)) or ca Customer Service. Work with your doctor (or other prescriber) to find a different drug that we cover. You can ca Customer Service to ask for a ist of covered drugs that treat the same medica condition. In some situations, we are required to cover a one-time, temporary suppy of a non-formuary drug in the first 90 days of coverage of the pan year or coverage. (To earn more about when you can get a temporary suppy and how to ask for one, see Chapter 3, Section 5.2 of the Evidence of Coverage.) During the time when you are getting a temporary suppy of a drug, you shoud tak with your doctor to decide what to do when your temporary suppy runs out. You can either switch to a different drug covered by the pan or ask the pan to make an exception for you and cover your current drug. Meanwhie, you and your doctor wi need to decide what to do before your temporary suppy of the drug runs out. Perhaps you can find a different drug covered by the pan that might work just as we for you. You can check the formuary on our Web site or ca Customer Service to ask for a ist of covered drugs that treat the same medica condition. This ist can hep your doctor to find a covered drug that might work for you. You and your doctor can aso ask the pan to make an exception for you and continue to cover the drug. You can ask for an exception in advance for next year and we wi give you an answer to your request before the change takes effect. There are certain requirements that must be met so to earn what you must do to ask for an exception, see the Evidence of Coverage that was incuded in the maiing with this Annua Notice of Changes. Look for Chapter 7 of the Evidence of Coverage (What to do if you have a probem or compaint (coverage decisions, appeas, compaints).). If you received a favorabe formuary exception during 2016, you may not need to obtain a new formuary exception in At the time of the approva, we woud have indicated in the approva notice how ong the authorization is vaid. Changes to Prescription Drug Costs

9 WeCare Cassic (PDP) Annua Notice of Changes for Note: If you are in a program that heps pay for your drugs ( Extra Hep ), the information about costs for Part D prescription drugs may not appy to you. We have incuded a separate insert, caed the Evidence of Coverage Rider for Peope Who Get Extra Hep Paying for Prescription Drugs (aso caed the Low Income Subsidy Rider or the LIS Rider ), which tes you about your drug costs. If you get Extra Hep and didn t receive this insert with this packet, pease ca Customer Service and ask for the LIS Rider. Phone numbers for Customer Service are in Section 8.1 of this booket. There are four drug payment stages. How much you pay for a Part D drug depends on which drug payment stage you are in. (You can ook in Chapter 4, Section 2 of your Evidence of Coverage for more information about the stages.) The information beow shows the changes for next year to the first two stages - the Yeary Deductibe Stage and the Initia Coverage Stage. (Most members do not reach the other two stages - the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs in these stages, ook at Chapter 4, Sections 6 and 7, in the encosed Evidence of Coverage.) Changes to the Deductibe Stage Stage 2016 (this year) 2017 (next year) Stage 1: Yeary Deductibe Stage During this stage, you pay the fu cost of your Tiers 2 to 5 drugs unti you have reached the yeary deductibe. The deductibe is $360. The deductibe is $400 on Tiers 2 to 5. During this stage, you pay $0.00 cost-sharing for drugs on Tier 1 and the fu cost of drugs on Tiers 2-5 unti you have reached the yeary deductibe.

10 WeCare Cassic (PDP) Annua Notice of Changes for Changes to Your Cost-sharing in the Initia Coverage Stage To earn how co-payments and coinsurance work, ook at Chapter 4, Section 1.2, Types of out-of-pocket costs you may pay for covered drugs in your Evidence of Coverage. Stage 2016 (this year) 2017 (next year) Stage 2: Initia Coverage Stage Once you pay the yeary deductibe, you move to the Initia Coverage Stage.During this stage, the pan pays its share of the cost of your drugs and you pay your share of the cost. Your cost for a one-month suppy fied at a network pharmacy with standard cost sharing: Tier 1 (Preferred Generic Drugs): You pay $0.00 per prescription. Your cost for a one-month suppy fied at a network pharmacy with standard cost sharing: Tier 1 (Preferred Generic Drugs): You pay $0.00 per prescription.

11 WeCare Cassic (PDP) Annua Notice of Changes for Stage 2016 (this year) 2017 (next year) The costs in this row are for a one-month (30-day) suppy when you fi your prescription at a network pharmacy that provides standard cost-sharing. For information about the costs for a ong-term suppy or for mai service prescriptions, ook in Chapter 4, Section 5 of your Evidence of Coverage. Tier 2 (Generic Drugs): You pay $8.00 per prescription. Tier 3 (Preferred Brand Drugs): You pay $47.00 per prescription. Tier 4 (Non-Preferred Brand Drugs): You pay 50% of the tota cost. Tier 2 (Generic Drugs): You pay $20.00 per prescription. Tier 3 (Preferred Brand Drugs): You pay $47.00 per prescription. Tier 4 (Non-Preferred Drugs): You pay 50% of the tota cost. We changed the tier for some of the drugs on our Drug List. To see if your drugs wi be in a different tier; ook them up on the Drug List. Tier 5 (Speciaty Tier Drugs): You pay 25% of the tota cost. Once your tota drug costs have reached $3,310, you wi move to the next stage (the Coverage Gap Stage). Tier 5 (Speciaty Tier Drugs): You pay 25% of the tota cost. Once your tota drug costs have reached $3,700, you wi move to the next stage (the Coverage Gap Stage). Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages - the Coverage Gap Stage and the Catastrophic Coverage Stage - are for peope with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, ook at Chapter 4, Sections 6 and 7, in your Evidence of Coverage.

12 WeCare Cassic (PDP) Annua Notice of Changes for SECTION 3 Other Changes Process 2016 (this year) 2017 (next year) We are changing your pan number. No action is required by you and your new ID Card wi refect this change. Your pan number is S Your pan number is S SECTION 4 Deciding Which Pan to Choose Section 4.1 If You Want to Stay in WeCare Cassic (PDP) To stay in our pan you don t need to do anything. If you do not sign up for a different pan by December 7, you wi automaticay stay enroed as a member of our pan for Section 4.2 If You Want to Change Pans We hope to keep you as a member next year but if you want to change for 2017 foow these steps: Step 1: Learn about and compare your choices You can join a different Medicare prescription drug pan, -- OR-- You can change to a Medicare heath pan. Some Medicare heath pans aso incude Part D prescription drug coverage, -- OR-- You can keep your current Medicare heath coverage and drop your Medicare prescription drug coverage. To earn more about Origina Medicare and the different types of Medicare pans, read Medicare & You 2017, ca your State Heath Insurance Assistance Program (see Section 6), or ca Medicare (see Section 8.2).

13 WeCare Cassic (PDP) Annua Notice of Changes for You can aso find information about pans in your area by using the Medicare Pan Finder on the Medicare website. Go to and cick Find heath & drug pans. Here, you can find information about costs, coverage, and quaity ratings for Medicare pans. As a reminder, we offer other Medicare prescription drug pans. These other pans may differ in coverage, monthy premiums, and cost-sharing amounts. Step 2: Change your coverage To change to a different Medicare prescription drug pan, enro in the new pan. You wi automaticay be disenroed from WeCare Cassic (PDP). To change to a Medicare heath pan, enro in the new pan. Depending on which type of pan you choose, you may automaticay be disenroed from WeCare Cassic (PDP). n n You wi automaticay be disenroed from WeCare Cassic (PDP) if you enro in any Medicare heath pan that incudes Part D prescription drug coverage. You wi aso automaticay be disenroed if you join a Medicare HMO or Medicare PPO, even if that pan does not incude prescription drug coverage. If you choose a Private Fee-For-Service pan without Part D drug coverage, a Medicare Medica Savings Account pan, or a Medicare Cost Pan, you can enro in that new pan and keep WeCare Cassic (PDP) for your drug coverage. Enroing in one of these pan types wi not automaticay disenro you from WeCare Cassic (PDP). If you are enroing in this pan type and want to eave our pan, you must ask to be disenroed from WeCare Cassic (PDP). To ask to be disenroed, you must send us a written request or contact Medicare at MEDICARE ( ), 24 hours a day, 7 days a week (TTY users shoud ca ). To change to Origina Medicare without a prescription drug pan, you must either: Send us a written request to disenro. Contact Customer Service if you need more information on how to do this (phone numbers are in Section 8.1 of this booket).

14 WeCare Cassic (PDP) Annua Notice of Changes for or - Contact Medicare, at MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenroed. TTY users shoud ca SECTION 5 Deadine for Changing Pans If you want to change to a different prescription drug pan or to a Medicare heath pan for next year, you can do it from October 15 unti December 7. The change wi take effect on January 1, Are there other times of the year to make a change? In certain situations, changes are aso aowed at other times of the year. For exampe, peope with Medicaid, those who get Extra Hep paying for their drugs, those who have or are eaving empoyer coverage, and those who move out of the service area are aowed to make a change at other times of the year. For more information, see Chapter 8, Section 2.2 of the Evidence of Coverage. SECTION 6 Programs That Offer Free Counseing about Medicare The State Heath Insurance Assistance Program (SHIP) is a government program with trained counseors in every state. You can find the name, phone number and address of your state s State Heath insurance Assistance Program isted in the Appendix at the back of your Evidence of Coverage. State Heath Insurance Assistance Programs are independent (not connected with any insurance company or heath pan). Each is a state program that gets money from the Federa government to give free oca heath insurance counseing to peope with Medicare. Counseors can hep you with your Medicare questions or probems. They can hep you understand your Medicare pan choices and answer questions about switching pans. You can ca your SHIP at the contact information isted in the Appendix at the back of the Evidence of Coverage. SECTION 7 Programs That Hep Pay for Prescription Drugs You may quaify for hep paying for prescription drugs.

15 WeCare Cassic (PDP) Annua Notice of Changes for Extra Hep from Medicare. Peope with imited incomes may quaify for Extra Hep to pay for their prescription drug costs. If you quaify, Medicare coud pay up to 75% or more of your drug costs incuding monthy prescription drug premiums, annua deductibes, and coinsurance. Additionay, those who quaify wi not have a coverage gap or ate enroment penaty. Many peope are eigibe and don t even know it. To see if you quaify, ca: MEDICARE ( ). TTY users shoud ca , 24 hours a day/7 days a week; The Socia Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users shoud ca, (appications); or Your State Medicaid Office (appications). Prescription Cost-sharing Assistance for Persons with HIV/AIDS. The AIDS Drug Assistance Program (ADAP) heps ensure that ADAP-eigibe individuas iving with HIV/AIDS have access to ife-saving HIV medications. Individuas must meet certain criteria, incuding proof of State residence and HIV status, ow income as defined by the State, and uninsured/under-insured status. Medicare Part D prescription drugs that are aso covered by ADAP quaify for prescription cost-sharing assistance through the AIDS Drug Assistance Program (ADAP) in your state. For information on eigibiity criteria, covered drugs, or how to enro in the program, pease ca your state's ADAP (the name and phone numbers for this organization are isted in the appendix in the back of the Evidence of Coverage.). SECTION 8 Questions? Section 8.1 Getting Hep from WeCare Cassic (PDP) Questions? We re here to hep. Pease ca Customer Service at (TTY ony, ca ) We are avaiabe for phone cas Monday-Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are avaiabe Monday-Sunday, 8 a.m. to 8 p.m. Cas to these numbers are free.

16 WeCare Cassic (PDP) Annua Notice of Changes for Read your 2017 Evidence of Coverage (it has detais about next year's benefits and costs) This Annua Notice of Changes gives you a summary of changes in your benefits and costs for For detais, ook in the 2017 Evidence of Coverage for WeCare Cassic (PDP). The Evidence of Coverage is the ega, detaied description of your pan benefits. It expains your rights and the rues you need to foow to get covered services and prescription drugs. A copy of the Evidence of Coverage is incuded in this enveope. Visit our Website You can aso visit our website at As a reminder, our website has the most up-to-date information about our pharmacy network (Pharmacy Directory) and our ist of covered drugs (Formuary/Drug List). Section 8.2 Getting Hep from Medicare To get information directy from Medicare: Ca MEDICARE ( ) You can ca MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca Visit the Medicare Website You can visit the Medicare website ( ). It has information about cost, coverage, and quaity ratings to hep you compare Medicare prescription drug pans. You can find information about pans avaiabe in your area by using the Medicare Pan Finder on the Medicare website. (To view the information about pans, go to and cick on Review and Compare Your Coverage Options. ) Read Medicare & You 2017 You can read Medicare & You 2017 Handbook. Every year in the fa, this booket is maied to peope with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequenty asked questions about Medicare. If you don t have a copy of this booket, you can get it at the Medicare website ( or by caing

17 WeCare Cassic (PDP) Annua Notice of Changes for MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca