Medicare – FAQs
The Hawaii Revised Statutes 87A-23(4) requires that State and county retirees and their eligible dependents, who are enrolled in EUTF retiree medical and/or prescription drug benefit plans, must be enrolled in Medicare Part B when they become eligible. Active employees considering retirement who are eligible for Medicare should enroll in Medicare Part B prior to retirement to ensure that their Medicare Part B is effective on the date of their retirement in order to participate in any EUTF retiree medical and/or prescription drug plan.
However, Section 87A-23(5) allows the EUTF Board to determine which retirees and dependents may continue to participate in the EUTF retiree medical and/or prescription drug plans even though they are not enrolled in Medicare Part B. Under this exception, the EUTF Board has allowed the following to continue to participate in EUTF retiree medical and/or prescription drug plans even if they are not enrolled in Medicare Part B: (a) retirees that attained age 65 prior to the enactment of the law that required all eligible Medicare participants to enroll in Medicare Part B; and (b) retirees who are not citizens of the United States or lawfully admitted aliens who have not lived in the United States for at least five years and are ineligible to be enrolled in Medicare.
Under current law, the amount of your Medicare Part B reimbursement is the amount you are charged by Medicare (minus any penalties for late enrollment). Generally, your reimbursement will be deposited quarterly during the first week of April, July, October and January for the prior quarter. If you became eligible for Medicare Part B after July 1, 2006, your reimbursements must be direct deposited into your financial institution account. A direct deposit agreement form must be submitted to the EUTF.
EUTF Administrative Rule 5.04 (a) states:
“If an employee-beneficiary becomes eligible to enroll and fails to enroll in the federal Medicare Part B medical insurance plan, the employee-beneficiary’s enrollment in the medical and prescription drug plans offered or sponsored by the Fund and the medical and prescription drug plan coverages for dependent-beneficiaries under that enrollment shall be cancelled.”
If the spouse/partner fails to enroll, then only the spouse/partner will be cancelled from medical and prescription drug plans offered by the EUTF. If your spouse/partner wants to continue coverage under your retiree plan, your spouse/partner is required to enroll in Medicare Part B even though he/she is still working. If you fail to enroll, you, your spouse and any other dependents will also be canceled from the medical and prescription drug plans. Enrollment in Medicare Part B is required to be eligible for coverage under the EUTF retiree medical and/or prescription drug plans.
If you are notified by Medicare that your Medicare Part B premium will have an income-related monthly adjustment amount, in other words your Medicare Part B premium is higher than the standard rate due to your higher income level, you will be reimbursed the higher amount. However, you MUST promptly (within two years) send the EUTF a copy of the letter from the Social Security Administration informing you of the higher Medicare premium.
EUTF automatically resets your Medicare Part B reimbursement to the Medicare standard rate every January 1st. Every year Medicare reviews your income and sets your Medicare Part B premium accordingly, so every year, you must notify EUTF of your higher than standard Medicare Part B premium in order to receive the full reimbursement.
Both the retiree’s Medicare reimbursement and the spouse/partner’s Medicare reimbursement must be deposited in the same account at the financial institution designated. The retiree must be an account holder on the designated account.
CMS allows all Medicare Part D plans to reach out to Medicare participants, beginning October 15th of each year. Other Medicare Part D plans may contact you to encourage enrollment in their plan during this time, thereby disenrolling you from the EUTF or HSTA VB Medicare Prescription Drug plan or Kaiser Permanente Senior Advantage medical and prescription drug plan, as applicable. EUTF does not share information about you with other non-EUTF Medicare Part D plans.
Please notify the EUTF in writing once you have enrolled in another Medicare Part D plan. If you enroll in a non-EUTF Medicare Part D plan, you will be disenrolled from the EUTF or HSTA VB Medicare Part D plan or the Kaiser Senior Advantage plan as applicable because Medicare allows you to enroll in only one Medicare Part D plan. If you are enrolled in the HSTA VB plans, you will also be disenrolled from the medical, vision, and chiropractic plans which are bundled with the HSTA VB prescription drug plan. The same applies to your spouse/partner if they choose to enroll in another Medicare Part D drug plan.
All Medicare Part D plans must offer a minimum coverage to meet the Standard Medicare Part D plan requirements. The EUTF and HSTA VB Medicare Part D plans (e.g., the prescription drug plan administered by SilverScript and the Kaiser Senior Advantage plan) exceed this minimum by offering participants:
- No annual deductibles
- Additional coverage during the Initial Coverage and Coverage Gap phases.
Please notify the EUTF in writing that you have enrolled in another non-EUTF Medicare Part D plan.
All Medicare members are enrolled in the Medicare Part D plan through Kaiser Permanente Senior Advantage. The EUTF enhances the Medicare Part D coverage with supplemental drug benefits that makes your Kaiser prescription drug coverage better than the standard Medicare Part D plan.
Pharmacy Benefit Managers such as SilverScript and health plans like Kaiser Permanente have committees of pharmacists and other health care providers who continually review drug data and studies on new and existing drugs. Based on this data they create prescription drug lists of those medications that have been shown to be the most effective at the most reasonable cost for each therapeutic class of medications.
CMS requires two drugs in every therapeutic category and class. CMS thoroughly evaluates the submitted formulary design to ensure that it contains adequate access to medically necessary drugs and does not discriminate against any groups of beneficiaries.
If you are enrolled in the EUTF prescription drug plan and your spouse/partner opts out of the plan, your spouse/partner will be disenrolled from the EUTF Medicare Part D plan.
Coordinating benefits between multiple plans follows standard nationally recognized rules for Coordination of Benefits. When Medicare is involved, the rules have been set by federal legislation which dictates when Medicare is the primary or secondary payer. Whether one plan is primary or secondary depends on the insured’s status and type of plan such as active employee or retiree; insured subscriber or dependent; Medicare or non-Medicare.
Additionally, each drug plan may have its own rules. Sometimes these rules conflict and it is not possible to receive payment from both plans. If you are currently coordinating multiple medical and prescription drug plan, please be aware that primacy rules may change and you may be subject to a copayment or coinsurance in which you weren’t previously subject to.
When you and/or your dependent enroll in Medicare Part B and are enrolled into the EUTF or HSTA VB Medicare Part D prescription drug plan as well as a non-EUTF group health plan (active employer plan), your Medicare Part D plan becomes secondary coverage to the non-EUTF group health plan. Medicare Part D coverage follows federally mandated secondary payer rules that may differ from other non-Medicare plans such as the EUTF or HSTA VB non-Medicare retiree prescription drug plan, and you may find that you have to pay a copayment even though you have dual coverage (more than one drug plan). Please contact SilverScript for more information on coordination of benefits and how their plan will coordinate with your non-EUTF active employer plan.
SilverScript will send you a notice if CMS identifies that you have other prescription drug coverage and/or other health insurance coverage. This notice will require you to review and correct any misrepresented information so that SilverScript may correctly pay your claims.
No, but EUTF encourages you to use mail order as it saves you time and money.
Yes. These are bundled coverages and cannot be enrolled in or disenrolled from separately. However, during the next open enrollment, you will be able to enroll in the EUTF (not HSTA VB) PPO medical and vision plans. Once you disenroll from HSTA VB plans, you will not be able to re-enroll in any HSTA VB plans in the future.
No. There are prescription drugs that may not be included under the Medicare Part D plan but are covered under the EUTF non-Medicare retiree plan. The formulary lists for the SilverScript plans are different from the EUTF and HSTA VB non-Medicare retiree plans. However, in April 2013, EUTF added a supplemental coverage to the SilverScript plans to more closely match the formulary drug lists of the non-Medicare plans.