The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.

State Seal

State Seal

GEORGE E. PATAKI
GOVERNOR

STATE OF NEW YORK
DEPARTMENT OF CIVIL SERVICE
THE STATE CAMPUS
ALBANY, NEW YORK 12239

DANIEL E. WALL
COMMISSIONER

JOHN F. BARR
EXECUTIVE DEPUTY COMMISSIONER

Medicare Part D

General
Joining Medicare Part D
Low Income Subsidy
Medicare Advantage HMO

Topic	Question	Answer
General	What is Medicare Part D?	Beginning January 1, 2006, new Medicare prescription drug plans will be available to people with Medicare Part A (Hospital) or Medicare Part B (Medical) coverage. Insurance companies and other private companies will work with Medicare to offer these drug plans. Like other insurance, if you join you will pay a monthly premium (generally around $37 in 2006) and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan.
General	What is NYSHIP?	NYSHIP is the New York State Health Insurance Program which provides health benefits to NYS employees and retirees and the employees and retirees of local governments that elect to participate in NYSHIP. Certain quasi-State agencies, such as authorities also participate in NYSHIP. If you are enrolled through the State you have the choice of enrolling in the Empire Plan or a NYSHIP approved HMO in your area. If you are enrolled through a local government your coverage is offered through the Empire Plan.
General	What if I have prescription drug coverage through NYSHIP?	If you have prescription drug coverage through NYSHIP, you should not enroll in Medicare Part D, unless you are eligible for the low income subsidy. As a NYSHIP enrollee or covered dependent eligible for Medicare in 2006, you will continue to be able to receive the full prescription drug benefits available to you under NYSHIP. There will be no change in your Prescription drug benefits just because of your (or your dependent’s) eligibility for Medicare You will not be required to enroll in Medicare Part D Please be aware that if you do enroll in Medicare Part D your ability to use your NYSHIP prescription drug benefits will be affected. Although most NYSHIP enrollees SHOULD NOT enroll in Medicare Part D, you should consider enrolling if you are eligible for the Medicare Part D Low Income Subsidy.
General	What is Creditable Coverage?	Creditable coverage means that the prescription drug benefit that retirees receive through their employer plan is, on average, at least as good as the coverage that you would receive under a Medicare Part D prescription drug plan. In most cases, your NYSHIP coverage is much better and more cost effective. However, there are certain situations where your NYSHIP coverage may not be as cost effective as the coverage you could receive under Medicare Part D. For example, if you are eligible for a low income subsidy for Medicare Part D coverage. You will need to compare your benefits, copays and deductibles under each plan to determine what is best for you. Creditable coverage also allows people to enroll in Medicare Part D at a later date, without penalty, as long as they do so within 62 days of losing their creditable coverage.
General	I have read about a 28% subsidy that employers are getting if their retirees don’t sign up for Medicare Part D. Does that mean we will get a refund?	The employer subsidy is an incentive under the Medicare Prescription Drug Program to encourage employers to maintain their current level of prescription drug benefit for their retirees. This means that you continue to receive a better level of coverage that is cost effective than what you would receive under Medicare Part D. It is also a more cost effective means for the Federal Government to ensure quality prescription drug coverage for retirees. The subsidy is payable to the employer and it is not required to be shared with retirees. NYS enrollees : Retirees will not a benefit from the employer subsidy PA/PE enrollees: Each Participating Agency and Employer can decide for themselves how to use the subsidy.
Joining Medicare Part D	What if I want to join a Medicare prescription drug plan?	If you currently have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance), you can join a Medicare prescription drug plan between November 15, 2005, and May 15, 2006. Beginning in October 2005, you also will be able to get information on the drug plans available in your area. It is important to remember that you will NOT be reimbursed for the Medicare Part D premium and your NYSHIP prescription drug benefits may be reduced. Although most NYSHIP enrollees SHOULD NOT enroll in Medicare Part D, you should consider enrolling if you are eligible for the Medicare Part D Low Income.
Joining Medicare Part D	How will my NYSHIP benefits be reduced if I am not eligible for the Low Income Subsidy, but enroll in Medicare Part D anyway?	If you choose to join a Medicare prescription drug plan, your NYSHIP prescription drug coverage will be affected in the following ways: Your Medicare drug coverage will become primary to your NYSHIP coverage. This means that you must use your Medicare prescription drug plan first and your NYSHIP coverage will reimburse you for covered expenses not paid by Medicare. If you are enrolled in The Empire Plan, you will have to use your Medicare prescription drug plan first and submit a claim form to The Empire Plan Prescription Drug Program for reimbursement of any remaining covered charges. If you are enrolled in a NYSHIP HMO, contact your HMO for information about how to use your drug benefit if you are also covered under a Medicare Part D prescription drug plan. There will be no reduction in the cost of your NYSHIP prescription drug coverage, unless you qualify for the Medicare Low Income Subsidy (see below for more information). Note: a no Rx option will be made available to NY enrollees eligible for the subsidy at a reduced premium; for PA/PE enrollees it will be at the option of the agency.
Joining Medicare Part D	If I don’t qualify for the Low Income Subsidy won’t I have better coverage is I have both Medicare Part D and NYSHIP prescription drug coverage?	Probably not. You will be responsible for paying the Medicare Part D premium and your out-of-pocket expense may end up being higher if you have both Medicare Part D and NYSHIP prescription drug coverage. You will receive more information about this from the Department of Civil Service when the details are finalized.
Low Income Subsidy	I received a letter from the Social Security Administration stating that I may be eligible for help to pay for Prescription Drug Costs. What do I do?	If you are eligible for both Medicare and Medicaid, you will automatically be signed up for Medicare Part D prescription drug coverage. You will be able to get help paying for your monthly premiums, deductibles and co-payments under the Medicare Part D prescription drug program. Therefore, having Medicare Part D coverage as your primary drug coverage is likely to result in lower out-of-pocket costs for you. Beginning in October 2005, you also will start to receive information on the drug plans available in your area. You may be (NY will be; PA/PE may be at the option of the agency) eligible to cancel your NYSHIP prescription drug coverage and receive your prescription drug coverage through a Medicare prescription drug plan. This will lower your NYSHIP premium. You and all your NYSHIP covered dependents must qualify for the Medicare Low Income Subsidy to be eligible to drop your NYSHIP prescription drug coverage. For NY enrollees: If you wish to drop your NYSHIP prescription drug coverage, contact the Employee Benefits Division at 1-800-833-4344 or 518-457-5754 (Albany area). Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. For PA/PE enrollees: If you wish to drop your NYSHIP prescription drug coverage, contact your former employing agency to find out if they offer a no-drug Empire Plan option to individuals eligible for the Low Income Subsidy at a reduced premium. Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. If you decide to decline the low income subsidy, you must specifically notify the Social Security Administration that you are declining the subsidy. If you do nothing, the SSA will randomly assign you to a part D program and begin the subsidy. If you have additional questions regarding the benefits you will receive under Medicare Part D, contact 1-800-MEDICARE (1-800-633-4227 4227 - representatives are available 24/7) or visit www.medicare.gov.
Low Income Subsidy	I received a letter from Medicare stating that I will automatically be signed up for the Medicare Part D Prescription Drug Benefit. What should I do?	If you are a Medicare beneficiary with limited income and resources, the prescription drug benefit you can receive under Medicare Part D may be better than the prescription drug benefit that you receive under NYSHIP. You may be able to get help paying for your monthly premiums, deductibles and co-payments under this prescription drug program. If you have both Medicaid with prescription drug coverage and Medicare, Medicare and Supplemental Security Income, or if your state pays for your Medicare premiums, you automatically will get this extra help. You do not have to do anything. If you have additional questions contact 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. It you received an Application for Help with Medicare Prescription Drug Plan Costs (Form SSA-1020) from the Social Security Administration, and wish to apply for the low income subsidy, you should complete and return it as soon as possible. Beginning July 1, 2005, you can also apply online at www.socialsecurity.gov. After you apply, Social Security will review your application and send you a letter to let you know if you qualify for the extra help. If you qualify, and you decide that you want Medicare Part D prescription drug coverage instead of NYSHIP prescription drug coverage you need to enroll in a Medicare-approved prescription drug plan to get help with your prescription costs. Beginning in October 2005, you will be able to get information on the drug plans available in your area. You can select a plan between November 15, 2005, and May 15, 2006, but the earlier you enroll in a plan, the sooner you can begin to save money on your prescription drugs through Medicare Part D. Different Medicare Part D plans may cover different prescription drugs. Be sure to consider the prescriptions you are currently taking before making a final decision. How can I get more information? For more information about getting help with your prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov. To learn more about the Medicare prescription drug plan, call 1-800-MEDICARE (1-800-633-4227 - representatives are available 24./7) or visit www.medicare.gov.
Low Income Subsidy	If I am approved for the low income subsidy and sign up for Medicare Part D, what happens to my NYSHIP coverage	If you are eligible for both Medicare and Medicaid, you will automatically be signed up for Medicare Part D prescription drug coverage. You will be able to get help paying for your monthly premiums, deductibles and co-payments under the Medicare Part D prescription drug program. Therefore, having Medicare Part D coverage as your primary drug coverage is likely to result in lower out-of-pocket costs for you. Beginning in October 2005, you also will start to receive information on the drug plans available in your area. You may be (NY will be; PA/PE may be at the option of the agency) eligible to cancel your NYSHIP prescription drug coverage and receive your prescription drug coverage through a Medicare prescription drug plan. This will lower your NYSHIP premium. You and all your NYSHIP covered dependents must qualify for the Medicare Low Income Subsidy to be eligible to drop your NYSHIP prescription drug coverage. For NY enrollees: If you wish to drop your NYSHIP prescription drug coverage, contact the Employee Benefits Division at 1-800-833-4344 or 518-457-5754 (Albany area). Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. For PA/PE enrollees: If you wish to drop your NYSHIP prescription drug coverage, contact your former employing agency to find out if they offer a no-drug Empire Plan option to individuals eligible for the Low Income Subsidy at a reduced premium. Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. If you decide to decline the low income subsidy, you must specifically notify the Social Security Administration that you are declining the subsidy. If you do nothing, the SSA will randomly assign you to a part D program and begin the subsidy. If you have additional questions regarding the benefits you will receive under Medicare Part D, contact 1-800-MEDICARE (1-800-633-4227 4227 - representatives are available 24/7) or visit www.medicare.gov.
Low Income Subsidy	If I am approved for the low income subsidy and sign up for Medicare Part D, what happens to my NYSHIP coverage	If you are approved for the Medicare Low Income Subsidy, you may be eligible to cancel your NYSHIP prescription drug coverage and receive your prescription drug coverage through a Medicare prescription drug plan. This will lower your NYSHIP premium. You and all your NYSHIP covered dependents must qualify for the Medicare Low Income Subsidy to be eligible to drop your NYSHIP prescription drug coverage. For NY enrollees: If you receive information from the Social Security Administration that states you have been approved for extra help under the Medicare Low Income Subsidy, contact the Employee Benefits Division at 1-800-833-4344 or 518-457-5754 (Albany area), if you wish to drop your NYSHIP prescription drug coverage. Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. For PA/PE enrollees: If you receive information from the Social Security Administration that states you have been approved for extra help under the Medicare Low Income Subsidy, contact your former employing agency to find out if they offer a no-drug Empire Plan option to individuals eligible for the Low Income Subsidy at a reduced premium , if you wish to drop your NYSHIP prescription drug coverage. Before you do this, you should compare your coverage under the Medicare Plan with your coverage under NYSHIP. Some drugs that you are taking may not be covered by Medicare. If you decide to decline the low income subsidy, you must specifically notify the Social Security Administration that you are declining the subsidy. If you do nothing, the SSA will randomly assign you to a part D program and begin the subsidy.
Low Income Subsidy	Is there someone who can help me decide whether my prescription drug benefits would be better under Medicare Part D or under NYSHIP?	For information about Empire Plan prescription drug benefits you can call 1-877-769-7447 and select the Prescription Drug Program from the menu. If you are in a NYSHIP HMO, call your HMO directly. Medicare also provides personal counseling about Medicare benefits and health plans through State Health Insurance Assistance Programs. (provide list of toll free #’s by state – see attachment). Representatives are available Mon – Fri from 9 – 5.
Low Income Subsidy	If I sign up for Medicare Part D because I am eligible for the Low Income Subsidy and drop my NYSHIP Prescription Drug Coverage but later I decide I want to change my prescription drug coverage from Medicare Part D to NYSHIP, what do I do?	You should contact 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov for information about when you may dis-enroll from Medicare Part D and what steps you should take to do so. To reinstate your NYSHIP prescription drug coverage contact the Department of Civil Service in writing.
Low Income Subsidy	What if I am automatically signed up for Medicare Part D because of my dual eligibility for Medicare and Medicaid, but I do not want this coverage?	You should contact 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. for information about the rules for dis-enrolling from Medicare Part D. If you do dis-enroll contact the Departmnt of Civil Service in writing to reinstate your primary NYSHIP prescription drug coverage. Before making a final decision, carefully review the benefits and costs of the Medicare Part D benefit compared to your NYSHIP coverage. For most people that are eligible for the low income subsidy, the Medicare Part D benefit will be better.
Low Income Subsidy	What if I decide I want to sign up for Medicare Part D after the initial enrollment period (11/15/05 – 5/15/06)? I don’t want to be billed a late penalty fee.	Since NYSHIP prescription drug coverage is, on average, is better than that provided under medicare Part D, your coverage under NYSHIP is considered “creditable coverage”. This means that if you later decide to enroll in a Medicare Prescription Drug Plan, you will not pay extra as long as you enroll within 63 days of terminating your NYSHIP prescription drug coverage. However, there may be limited times during the year that you can join a Medicare prescription drug plan and you may have to wait until the annual enrollment period next November to enroll if your NYSHIP prescription drug coverage ends mid-year.
Medicare Advantage HMO	I am enrolled in a Medicare Advantage HMO through NYSHIP. What is going to happen to my prescription drug coverage?	Currently you hospital and medical benefits are covered under the Medicare Advantage Plan. Your prescription drug coverage is covered through a separate plan with your HMO. Beginning January 1, 2006, you prescription drug coverage will be covered under Medicare Part D, through your Medicare Advantage HMO. You will not have to sign up separately for Medicare Part D, or pay an additional monthly premium. Contact your HMO for more information
Medicare Advantage HMO	I am thinking of enrolling in non-NYSHIP Medicare HMO on an individual basis in addition to my NYSHIP coverage. Will this affect my NYSHIP coverage?	Enrolling in a Medicare Advantage Plan not offered by NYSHIP is likely to drastically reduce your benefits available under your NYSHIP coverage. If you join one of these HMOs it will become your Medicare coverage. The Empire Plan and NYSHIP HMO’s that coordinate benefits will not provide coverage for any benefits that could be obtained through the Medicare Advantage Plan – this means you will have very little additional coverage under NYSHIP. Additionally, all Medicare Advantage Plans include Medicare Part D prescription drug coverage. This means that Medicare will become your primary coverage for prescription drugs and, under the Empire Plan, you will be required to submit paper claims to obtain any additional reimbursement available. If your NYSHIP coverage is with an HMO, check with your HMO to find out how enrolling in a Medicare Advantage plan on an individual basis will affect you NYSHIP drug coverage.

Updated 9/27/05