Frequently Asked Questions

Medicare Prescription Drug Plans

• Understanding Your Coverage
• Eligibility, Annual Enrollment, and Exceptions
• Paying for Coverage
• Understanding the Gap
• Financial Help
• Getting Your Prescriptions

Understanding Your Coverage

What is Medicare Prescription Drug coverage (Medicare Part D)?
Medicare prescription drug coverage (Part D) is insurance provided by private companies that provide voluntary outpatient prescription drug coverage for people on Medicare. Part D became effective in 2006 and is administered through private plans that are approved by the federal government via CMS (Centers for Medicare and Medicaid Services).

Medicare prescription drug coverage (Part D) is available to everyone entitled to Medicare Part A and/or enrolled in Part B. The Medicare drug benefit should help reduce prescription drug costs and help protect against higher (catastrophic) costs in the future. When you get Medicare prescription drug coverage, you will pay some of the costs and Medicare will pay some of the costs. Your costs will vary depending on the plan you choose. You typically enroll for coverage for a calendar year.

Who is eligible for Medicare Part D?
Anyone who lives in the geographic service area and is entitled to Medicare Part A and/or enrolled in Medicare Part B is entitled to Medicare prescription drug coverage, regardless of income. No physical exams are required. Nobody can be denied for health reasons.

How do I get this coverage?
You’ll need to enroll in a Medicare Part D plan offered in your area. There are two types of prescription drug plans available:

• "Stand alone" Part D plans that cover only Part D prescription drugs
• Medicare Advantage Prescription Drug Plans (MAPD) plans, which cover medical and prescription drug costs.

What if I already have prescription drug coverage?
You can only be enrolled in one Medicare Part D plan each year. You should talk to your plan, benefits administrator or insurer before making any changes. You will be notified about any changes in your current coverage so you can decide if you should join a Medicare Part D plan or switch from your current Part D plan.

Will everyone get the same coverage?
No. While each plan must offer coverage that is at least as good as the "standard" Medicare Part D benefit, coverage and costs can vary.

You may receive assistance with your out-of-pocket costs if your income is limited, if you are in a state pharmacy assistance program, or you have employer or union-sponsored retirement coverage. Refer to the Financial Help section for more information.

Are all drug plans the same?
No. There could be differences in monthly premium, deductible, covered drugs, copay or coinsurance levels and the pharmacies that you can use. Some plans offer supplemental benefits, such as additional prescription drug coverage in the coverage gap. To determine which plan is best for you, compare plans in your area to learn what your benefits and estimated costs will be.

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Eligibility, Annual Enrollment, and Exceptions

When can I enroll in a Medicare Part D plan?
You can join a plan if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and live in the service area. Specific enrollment periods for when you can enroll include:

• Initial Enrollment Period (IEP) - All individuals have an IEP. If you are just turning age 65, you can enroll in a Part D plan during the month of your 65th birthday, as well as three months before and after your birthday month.



• Annual Election Period (AEP) - The AEP occurs every fall. The AEP for 2013 runs from October 15 through December 7, 2012. You can make as many plan changes as you want during the AEP, but the last election you make during this period becomes effective on January 1, 2013.



• Special Enrollment Periods (SEPs) - SEPs allow individuals in specific situations (for instance, moving into a new service area, losing employer group coverage, or a benefit plan termination by CMS) to make changes to their current Medicare benefit plan outside of the normal enrollment periods. SEPs exist year-round for dual-eligible and LIS individuals or those in Chronic Care Special Needs plans.



• Open Enrollment Items to Consider
  
  
  • If you are enrolled in a Medicare Advantage coordinated care plan (like an HMO or PPO) or a Medicare Advantage private fee-for-service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a Part D plan unless you disenroll from the HMO, PPO or MA-PFFS plan.
  • You may enroll in a Part D plan if you are in a private fee-for-service plan that does not provide Medicare prescription drug coverage, or a Medicare Advantage Medical Savings Account (MSA). You can also enroll in a Part D plan if you are enrolled in an 1876 Cost plan.
  • You should consider if you have other sources of prescription drug coverage -- for example, benefits from a current or former employer or union. If you have questions, check with your employer or union. However, if that drug coverage is not at least as good as standard Medicare prescription drug coverage (creditable coverage) you may have to pay a penalty.

Is there a penalty for signing up late?
Yes. You may pay a late enrollment penalty if you did not enroll in a plan offering Medicare Part D coverage when you first became eligible for this drug benefit or had a break in coverage for 63 days or more.

Medicare will determine the amount of the penalty. The penalty is 1% for every month that you did not have credible coverage. Medicare will calculate the average monthly premium for all Medicare drug plans in the nation and multiply the 1% per month times this average.

You will not have to pay a premium penalty for late enrollment in certain situations, for example, if you are receiving Extra Help. There are three important things to understand about the monthly premium penalty:

• The penalty will change every year because the average national premium calculated by Medicare can change each year.
• You will continue to pay a penalty every month as long as you are enrolled in a plan that has Medicare Part D drug benefits.
• The late enrollment penalty will reset when you turn age 65 if you are currently under 65 and have a Medicare Part D drug benefit. After age 65, your penalty will be based only on the months that you do not have coverage after your initial enrollment.

Will my costs change after I enroll?
The premium, deductible and copay/coinsurance for the plan you are enrolled in cannot change during the plan year. (January 1st through December 31st), but may change from one plan year to the next.

However, a drug may move from one tier (cost group) to a different tier (cost group) during the year. These changes must be approved by Medicare. Your copay or coinsurance could change, depending upon the tier change. (There are rules that plans must follow if a drug is moved to a higher tier and has a more expensive copay/coinsurance.)

Benefits, formulary, pharmacy network, premium, copay/coinsurance may change from one plan year to the next plan year.

What if I have drug coverage from my job or retiree benefits?
The coverage offered by your employer may be better than the standard Medicare drug benefit. You should have received notice from your former or current employer explaining whether your coverage is "creditable," meaning it is at least as good as the standard Medicare prescription drug benefit. If you did not receive this information, you should contact your employer.

If your drug plan is "creditable," you may keep your employer plan and you will not pay a late enrollment penalty. You may also enroll in a new Medicare Part D plan. Check with your employer to understand the impact that the joining a new plan will have on your coverage. Be sure to evaluate the benefits offered under your employer plan with the benefits offered by Medicare drug plans in your area to be sure you choose the best plan for your needs.

If your employer plan does not qualify as "creditable coverage," you may pay a late enrollment penalty if you do not enroll in a plan offering Medicare Part D coverage when you first become eligible for this drug benefit, or if you have a break in coverage for 63 days or more. Your current or former employer or union must tell you if your present plan may change if you enroll in a Medicare Part D plan.

I have prescription drug coverage from an employer/union plan. Should I apply for Extra Help?
Even with employer/union coverage, individuals with limited income and resources may qualify for Extra Help. If you have employer/union coverage you should talk with your plan or benefits administrator to find out how your employer/union coverage will work with Medicare prescription drug coverage. If you qualify for Extra Help, you should also contact your State's Health Insurance Assistance Program (SHIP). Customer service representatives at 1-800-MEDICARE (1-800-633-4227) (TTY/TDD users call 1-877-486-2048) 24 hours a day, 7 days a week, can provide the SHIP number for your home state. A SHIP counselor can provide personalized assistance to help you decide whether it is better to keep the employer or union drug coverage or get Medicare prescription drug coverage.

What if I have Medigap coverage?
If you have a Medigap (Medicare Supplement Insurance) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Part D plan. If you decide to keep your current Medigap policy, your Medigap issuer will remove the prescription drug coverage portion from your Medigap policy. This will occur as of the effective date of your Medicare Part D coverage. Your issuer will adjust your premium.

Call your Medigap issuer for details. If you or your spouse has, or is able to get, employer group coverage, you should talk to your employer to find out how your benefits will be affected if you join a Part D plan. Get this information before you decide to enroll.

What if I have veterans or military retiree drug benefits?
You will not pay a penalty if you later lose this coverage and switch to a Medicare drug plan within 63 days. But if your income is low enough to qualify for Extra Help it is worth comparing those benefits with what you have now.

What if I receive prescription drug coverage through a Medicare Advantage plan?
If you are enrolled in a Medicare Advantage plan such as an HMO or PPO that includes prescription drug coverage, you may not enroll in a Medicare Part D plan unless you disenroll from the Medicare Advantage plan.

What if I purchase my prescription drugs from outside of the United States?
Medicare plans will not cover drugs purchased outside the United States.

Are there programs to help people with limited incomes?
There are two basic kinds of assistance to help people in paying for their prescription drugs:

• Extra Help from Medicare - This is commonly referred to as Low Income Subsidy or LIS. If your annual income and resources are below certain levels, you can qualify for this help. If you qualify for both Medicaid and Medicare, you automatically qualify for financial help and are fully subsidized by Medicare. Learn more about this program by calling 1-800-MEDICARE (1-800-633-4227). TTY/TTD users should call 1-877-486-2048. You can also submit an application online at www.ssa.gov.
• State Pharmacy Assistance Programs (SPAPs) - Many states help you pay for your prescription drugs through State Pharmacy Assistance Programs based on financial need, age, or medical condition. Since states can have different rules, check with your State Health Insurance Assistance Program.

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Paying for Coverage

What are the out-of-pocket costs for standalone Medicare prescription drug coverage?
You pay a monthly premium to your plan. You also pay part of your pharmacy drug costs and Medicare (your plan) pays part of the pharmacy drug costs.

Your costs will vary depending on which plan you choose. However, your plan must, at a minimum, provide a standard level of Medicare prescription coverage.

How does the 2013 Standard Medicare Part D work?


The Standard Medicare Part D program works like this:

• You pay amonthly premium.
• Deductible Stage - You pay a $325 deductible, which means that you will pay 100% of your discounted prescription costs until you meet this deductible amount.
• Initial Coverage Stage - After you meet your deductible, you have initial coverage, in which you pay 25% of discounted prescription drug costs up to a predetermined limit. For 2013, this amount is $2,970 and is based upon total drug costs (what both you, and others on your behalf, and your Part D plan pay)
• Coverage Gap Stage - After your yearly total drug costs reach $2,970, you move into the coverage gap stage. For 2013, you will pay 47.5% of the manufacturer’s discounted brand-name drug price and 79% of generic drug costs. You’ll also pay 47.5% of any dispensing fees and vaccine administration fees.
  
  If you are receiving Low Income Subsidy "Extra Help," these discounts are not applicable — you already have coverage through the gap.
• Catastrophic Coverage Stage - You will remain in the coverage gap until your total out-of-pocket costs reach $4,750, at which time you move into the catastrophic stage for the remainder of the calendar year.

  You'll pay the higher of:

  • 5% of the discounted prescription drug costs or
  • $2.60 copay for generic (including brand drugs treated as generic) or $6.50 copay for all other drugs
  • These values are set by Medicare on an annual basis.

Are there any cost breaks for married couples?
No. Medicare requires each spouse to pay separate premiums, deductibles and copays and coinsurance for prescription drug coverage and will reach each level of coverage according to his or her own drug costs over each calendar year.

Is there an extra Medicare Part D premium amount because of my income level?
Most people will pay the standard monthly Part D premium. However, you may have to pay an extra amount because of your annual income. Singles or married individuals filing separately whose income is $85,000 or above, and couples with an income of $170,000 will pay the extra amount.

If you are impacted, the Social Security Administration (not your Medicare Part D plan) will send you a letter telling you what the amount will be and how to pay it. This extra amount must be paid separately and cannot be paid with your monthly Part D premium.

How can I pay the plan premium?
There are three ways you can pay your plan premium.

Option 1: By check
You may decide to pay your monthly plan premium directly to our Plan with a check or money order made payable to Cigna Medicare Rx (PDP) and mail it to:

Cigna Medicare Rx
P.O. Box 747102
Pittsburgh, PA 15274-7102

You may not drop off a check in person. Your premium check must be received by the 1st day of the covered month (for example, your payment must be received by January 1st for January coverage).

Option 2: By direct debit
Instead of paying by check, you can have your monthly plan premium automatically withdrawn from your bank account or charged directly to your credit or debit card. To make this election, you must complete and sign the appropriate form in your Welcome Kit and return it to Cigna Medicare Rx. You can call to request the paperwork, but you will not be able to make this election by phone.

Option 3: Taken out of your monthly Social Security/Railroad Retirement Board benefit check
For more information on how to pay your monthly plan premium this way, contact Cigna’s Customer Service at 1-800-222-6700 (TTY/TDD users call 1-800-322-1451) 8 am to 8 pm local time, 7 days a week. We will be happy to help you set this up.

In most cases, if Social Security/the Railroad Retirement Board accepts your request to have your premium automatically deducted, the first deduction from your benefit check will include all premiums due from your enrollment effective date to the point that withholding begins.

The Social Security Administration/Railroad Retirement Board has an approval process that can take 2 months or more. If there is a delay or you are not approved, we will send you a paper bill for your monthly premiums.

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Understanding the Gap

What changes in the coverage gap can I expect for 2013 as a result of Health Care Reform?
Manufacturer discounts will continue to be applied when you reach the coverage gap. In 2013, you will pay 47.5% of the cost of brand-name drugs and 47.5% of any dispensing fees and vaccine administration fees.

• The discount will automatically be applied when you reach the coverage gap at the time you fill your prescription at a network pharmacy.
• Your Explanation of Benefits (EOB) will identify the discount you received. And, both the manufacturer discount and what you pay are both applied to your out-of-pocket expenses and moves you through the coverage gap to catastrophic coverage.
• You will also continue to receive a discount for generic drugs when you are in the coverage gap. This year, you will pay a coinsurance amount of 79%.
• The amount paid by the plan does not count towards your out-of-pocket costs. Only the amount you pay will count towards these costs and move you though the coverage gap. The dispensing fee is already included in the cost of the drug.



If you are already receiving Extra Help (also called Low Income Subsidy, or LIS) these changes do not apply since you already receive coverage in the gap.

Are there plans that provide additional coverage in the coverage gap beyond what Medicare will now provide?
Yes. There are plans that provide additional coverage in the coverage gap. This additional gap coverage varies by plan and generally has a higher premium.

Cigna Medicare Rx Plan Two provides further savings and peace of mind with additional gap coverage for all Tier 1 drugs. With Plan Two, you will pay a $0 copay for all Tier 1 drugs, including high blood pressure, high cholesterol, diabetes, glaucoma and thyroid medications, all the way through the coverage gap. Plan Two is offered in many states.

You may or may not enter the coverage gap, depending upon the type of covered prescription drugs you take, the drug costs and what you pay. Since these factors may vary by plan, it is important to explore what the right plan is for you based on your unique needs.

What counts toward my true out of pocket (TrOOP) costs?


Medicare has rules that each Part D plan must follow when we keep track of your out-of-pocket costs for your drugs.

The following payments count towards your out-of-pocket costs as long as they are for Part D-covered drugs and the rules for drug coverage are followed:

• The amount you pay for drugs when you are in any of the drug payment stages, including the deductible stage (if applicable to your plan)
• Your copays and coinsurance during the initial coverage stage
• What you spend on drugs during the coverage gap stage
• Any payments you made during the current calendar year under another Medicare prescription drug plan before joining a new plan

Payments for the above count towards your TrOOP costs if they are made by any of the following:

• You
• A friend, relative or many charities on your behalf
• AIDS Drug Assistance Programs
• Indian Health Service
• State Pharmaceutical Assistance Program (SPAP) qualified by Medicare
• a Medicare Coverage Gap Discount Program (including what the drug manufacturer pays as part of the brand-name discount)
• Medicare's Extra Help

In all cases, only payments for drugs your plan covers, including any "exceptions" you receive, count toward the TrOOP limit.

The following types of payments do not count towards your TrOOP limit:

• The amount you pay for your monthly premium
• Drugs you buy outside the United States and its territories
• Drugs that are not covered by our plan
• Drugs you get at an out-of-network pharmacy that do not meet the plan's requirements for out-of-network coverage
• Non-Part D drugs, including prescription drugs covered by Part A or Part B and other drugs excluded from coverage by Medicare
• Payments you make toward prescription drugs not normally covered in a Medicare Prescription Drug Plan
• Payments for your drugs that are made by group health plans including employer health plans.
• Payments for your drugs that are made by insurance plans and government-funded health programs such as TRICARE and the Veteran's Administration.
• Payments for your drugs made by a third-party with a legal obligation to pay for prescription costs (for example, Worker's Compensation).

How can I keep track of my out-of-pocket costs?
You will receive an Explanations of Benefits (EOB) statement from your Part D plan that includes the current amount of your out-of-pocket expenses along with other important information, such as what Part D Medicare stage (the deductible, initial coverage, gap coverage, and catastrophic coverage stages are described above) you are in. The EOB is sent to you on a monthly basis assuming you filled prescriptions in a given month.

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Financial Help

What is financial help?
Medicare provides assistance, known as Extra Help, in paying for prescription drug costs for those with limited income and resources.

If you qualify, you will receive help paying for any Medicare drug plan's monthly premium, annual deductible (if applicable) and prescription copays or coinsurance. This Extra Help will count towards your out-of-pocket expenses.

How do I know if I qualify for financial help?
People who receive full Medicaid benefits are automatically eligible for Extra Help with their drug costs and do not need to apply separately for the Extra Help. Medicare will mail a letter to people who automatically qualify for this assistance.

People who receive any help from Medicaid paying their Medicare premiums or receive Supplemental Security Income automatically receive Extra Help and do not need to apply separately. However, these individuals will need to enroll in a Medicare prescription drug plan.

Those who do not receive assistance from Medicaid but have limited income and resources are encouraged to apply for Extra Help and enroll in a Medicare drug plan. To receive assistance with the Medicare drug benefit, the following steps must be completed:

• Apply for Extra Help based on your income and resources; and
• Sign up for a prescription drug plan to begin using the benefit.

How can I get Extra Help with my prescription drug plan costs?
If you qualify for Extra Help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join Cigna Medicare Rx, Medicare will tell us how much Extra Help you are getting. Then we will let you know the amount you will pay.

If you are not getting this Extra Help you can see if you qualify by calling 1-800-MEDICARE (1-800-633-4227). TTY/TTD users should call 1-877-486-2048. You can also submit an application online at www.ssa.gov.

You may also receive help paying for your Part D prescription drugs through a State Pharmacy Assistance Program (SPAPs). Many states help you pay for your prescription drugs through SPAPs based on financial need, age, or medical condition. Since states can have different rules, check with your State Health Insurance Assistance Program.

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Getting Your Prescriptions

What is a formulary?
A formulary (or drug list) lists all drugs that we cover. We will generally cover the drugs on our drug list as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other coverage rules are followed.

Each plan must follow the rules set forth by Medicare in covering Part D drugs. In addition, Medicare must approve our drug list each year and as changes are made.

The drugs on the drug list are selected by our Plan with the help of a team of health care professionals. We select the prescription therapies believed to be a necessary part of a quality treatment program. Both brand-name drugs and generic drugs are included on the list of covered drugs.

Not all drugs are included on the drug list. In some cases, the law prohibits Medicare coverage of certain types of drugs. In other cases, we have decided not to include a particular drug on our drug list because we may have an alternative drug that can be taken. This is one example.

Will my drugs be covered?
Whether your drug is covered will depend on whether it is on the plan's list of covered drugs. Medicare prescription drug plans must include at least two drugs in every drug category. In addition, each Part D plan must:
• Make sure you have convenient access to retail pharmacies.
• Have a process to request exceptions to the drug list regarding our coverage rules.
• Provide useful information to you, such as how drug lists and medication management programs work, information on saving money with generic drugs, and grievance and appeal processes.

What if my drug is not in the drug list?
For information on how to obtain an exception to the Cigna Medicare Rx Prescription drug plan list of covered drugs, contact Cigna Medicare Rx (PDP) Customer Service, 8 am to 8 pm local time, 7 days a week.

Can the drug list change?
We may make certain changes to our list of covered drugs during the year. Changes in the drug list may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from our drug list, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost cost-sharing tier, we will post a notice on this site at least 60 days before the change becomes effective. In addition, you will be notified on your Explanation of Benefits (EOB) mailing, if you are taking the impacted drug.

If the FDA deems a drug on our list of covered drugs unsafe, or if a drug is removed from the market by the manufacturer, we will take appropriate actions to help ensure the safety of our customers. These actions may include removing the drug from the drug list. If we do remove the drug, we will provide notification to customers who are taking the drug.

Are generic drugs covered?
All Cigna Medicare Rx prescription drug plans cover both brand-name drugs and generic drugs. Generic drugs have the same active-ingredients as brand name drugs. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

Are there restrictions on my drug coverage?
There are some covered drugs on the drug list that have additional requirements or limits on coverage. These include:

• Prior Authorization - you or your doctor may be required to get a prior authorization for some drugs. This means that you will need to get approval from you plan prior to filling your prescription. If you do not obtain approval, the drug may not be covered.
• Quantity Limits - For some drugs, the quantity that is covered may be limited by the plan.
• Step Therapy - you may be required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

What about drugs that Medicare Part B already covers?
Medicare requires that certain medications and durable medical equipment (like diabetic test strips, nebulizers and wheelchairs) be covered under Part B. Medicare Part D plans usually do not cover drugs that are covered under Medicare Part B.

Medicare Part B will typically cover drugs that are administered at a hospital or doctor's office.

Where can I get my prescriptions filled?


In order to receive plan benefits, you must use a network pharmacy, and quantity limitations, and restrictions may apply. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

• If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
• If you are trying to fill a covered prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).
• If a covered Part D drug is dispensed by an out-of-network, institution-based pharmacy to a patient who is in the emergency department, provider-based clinic, outpatient surgery or other outpatient settings.

The Cigna Medicare Rx network of over 64,000 network pharmacies may change at any time. Visit the Pharmacy Directory or call our Customer Service team at 1-800-222-6700 from 8 am to 8 pm local time, 7 days a week. (TTY/TDD users call 1-800-322-1451).

How will the pharmacist know what to charge me?
You will present your plan's prescription drug card at the pharmacy or send the prescription drug card number if you're using a mail-order pharmacy. The card will electronically access your information - whether or not you still have part of your deductible to pay, what coverage you're entitled to, whether you have extra coverage that reduces your cost and what your copay or coinsurance should be.

What if I take multiple drugs for a chronic illness?
If you have a chronic illness, you may have the option of receiving your routine maintenance prescription medications through Cigna Home Delivery Pharmacy.

Does Cigna offer Home Delivery (Mail-Order)?
Yes, Cigna offers Home Delivery of your Part D prescription drugs. You may save money by using Cigna Home Delivery Pharmacy which provides:

• Free & quick delivery of all your prescriptions
• Refill reminders to help ensure you don't miss a dose
• FDA-approved medications
• Confidential, tamper-resistant packaging
• Pharmacists available day or night to answer your questions

If you receive state help in paying for your prescription drugs: contact your State Pharmacy Assistance Program (SPAP) as they may have specific requirements that limit your Home Delivery benefit.

Will I be able to get up to a 90-day supply of my drugs?
Yes. Up to a 90 day supply is available through our mail-order pharmacies, including Cigna Home Delivery Pharmacy and most of our network retail pharmacies.

For customers who take multiple medications, the Medication Therapy Management (MTM) program may be able to help.

MTMP is a program that may assist qualified Cigna Medicare Rx customers who:

• Take multiple prescription drugs
• Have chronic conditions
• Expect to spend a significant amount of money on prescription drugs each year

MTMP can help identify potential errors and gaps in your care by:

• Helping reduce the risk of medication errors - especially if you have chronic conditions, take several medications or see multiple doctors
• Providing current information on proven medical practices to help you and your doctor determine the most effective treatment
• Helping you understand your condition and medications, so you can take an active role in managing your health.

Learn more about our Medication Therapy Management Program.

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Medicare Advantage Prescription Drug Plans

• Understanding Your Coverage
• Eligibility, Annual Enrollment, and Exceptions
• Getting Your Prescriptions
• Paying for Coverage
• Financial Help

Understanding Your Coverage

What is a Medicare Advantage Prescription Drug Plan?
A Medicare Advantage Prescription Drug (MAPD) plan is a benefits package that provides both medical and Part D pharmacy coverage for beneficiaries. Cigna Medicare Select Plus Rx (HMO) plans are Medicare Advantage Prescription Drug Plans offered in Maricopa County and certain zip codes within Apache Junction and Queen Creek, Arizona.

What is the difference between a Medicare Advantage Prescription Drug Plan and a Medicare Prescription Drug Plan?
a Medicare Advantage Prescription Drug Plan provides medical and pharmacy coverage while a Medicare Prescription Drug Plan provides pharmacy coverage only. If you're enrolled in a Medicare Advantage Prescription Drug Plan you do not need to also be enrolled in a Medicare Prescription Drug Plan.

What other benefits are available through a Medicare Advantage Prescription Drug Plan?
MAPD plans generally offer benefits above and beyond what Original Medicare covers, including worldwide emergency and urgent care, hearing and vision services, preventive health and wellness programs.

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Eligibility, Annual Enrollment, and Exceptions

When am I eligible to enroll in a Medicare Advantage Prescription Drug Plan?
There are specific enrollment periods when you can enroll in an MAPD plan:

• Initial Enrollment Period (IEP) - This is a seven-month period that begins three months before the month that you're eligible for Medicare and ends three months after the month of eligibility (generally your birth month).
• Annual Enrollment Period (AEP) - The AEP occurs October 15^th through December 7^th in 2012 and is the time when you can switch to another Medicare Advantage or Prescription Drug Plan. The new plan coverage will be effective beginning January 1.
• Special Enrollment Periods (SEPs) - Certain circumstances allow member to change plans outside of the Annual Enrollment Period. Examples of such circumstances include moving out of the plan's service area or involuntary loss of health plan coverage

The Medicare prescription drug program is voluntary, however, if you don't sign up for a Part D prescription drug plan when you are first eligible and wish to sign up later, you may have to pay a penalty.

When can I enroll in a Medicare Advantage Prescription Drug Plan?
Beneficiaries can enroll in a Medicare Advantage Prescription Drug Plan this year between October 15^th and December 7^th. Enrollment will be effective January 1, 2013.

Who is eligible to enroll in a Medicare Advantage Prescription Drug Plan?
In order to enroll in a MAPD plan, you must be entitled to Medicare Part A, and enrolled in Medicare Part B and live in the service area. The service area for Cigna Medicare Select Plus Rx plans is Maricopa County and certain Zip codes in Apache Junction and Queen Creek, Arizona. Generally, individuals with End Stage Renal Disease are not eligible to enroll in a Medicare Advantage Prescription Drug Plan.

Can I switch my Medicare Advantage Prescription Drug Plan?
Normally, you can only change plans once a year between October 15^th and December 7^th. However, there are some exceptions. For example, if you move out of your plan's service area. For more information about enrollment period exceptions, contact us.

Getting Your Prescriptions

How can I find out what drugs are covered under a Medicare Advantage Prescription Drug Plan?
MAPD plans use a formulary, which is a list of covered drugs provided by the plan. To find out if your drugs are covered, call the plan and ask for a copy of the drug list. The drug list will note the covered drugs as well as what tier each drug is on and how much you'll pay for each drug. Click here to view Cigna Medicare Select Plus Rx drug list.

What if my drug is not on the list?
If a drug you are currently taking is not on our list of covered drugs, you may be eligible for an exception. For information on obtaining an exception to the Cigna Medicare Select Plus Rx drug list, please call Customer Service at 1-800-627-7534 (TTY: 1-800-987-8816), 7 days a week, 8 am to 8 pm (February 15 - September 30, 2013: Monday - Friday, 8 am to 8 pm Arizona time (a voicemail system is available on weekends and holidays).

Can the drug list change?
The Cigna Medicare Select Plus Rx drug list (formulary) may change during the year. Changes to the drug list include removing a drug from the list, adding quantity limits on a drug or moving a drug to a different cost-sharing tier. If any of these changes occur, a notice will be posted on this site informing customers of the change.

If the Food and Drug Administration (FDA) deems a drug on our drug list unsafe, or if a drug is removed from the market by the manufacturer, we will take appropriate actions to help ensure the safety of our customers. These actions may include removing the drug from the drug list. If we do remove the drug, we will provide notification to customers who are taking the drug.

Are generic drugs covered?
All Cigna Medicare Select Plus Rx plans cover both brand-name and generic drugs. Generic drugs have the same active ingredients as brand-name drugs, usually cost less than brand-name drugs and are rated by the FDA to be as safe and effective as brand-name drugs.

Where can I get my prescriptions filled?
In most cases, Cigna Medicare Select Plus Rx customers must have their prescriptions filled at one of the Cigna Medical Group pharmacies, located throughout the Valley. Under limited circumstances, such as when you are traveling outside of the service area, you can have prescriptions filled at a non-network pharmacy. For a list of Cigna Medical Group pharmacies, consult the Cigna Medicare Select Provider Directory or call Customer Service.

Cigna Medicare Select Plus Rx customers who live in the Wickenburg area have access to a limited number of retail pharmacies in Wickenburg. For a list of these pharmacies, see the Provider Directory.

Can I get extended-day supplies of maintenance medications?

Extended-day supplies of certain medications are available through the Cigna Home Delivery Pharmacy.

For customers who take multiple medications, the Medication Therapy Management (MTM) program may be able to help.

The MTMP program is for Cigna Medicare Select Plus Rx customers who:

• Take multiple prescription drugs
• Have chronic conditions
• Expect to spend a significant amount of money on prescription drugs each year

MTMP can help identify potential errors and gaps in your care by:

• Helping reduce the risk of medication errors - especially if you have chronic conditions, take several medications or see multiple doctors
• Providing current information on proven medical practices to help you and your doctor determine the most effective treatment

Helping you understand your condition and medications, so you can take an active role in managing your health.

Paying for Coverage

What are the out-of-pocket costs on a Medicare Advantage plan?
When you're a member of a Medicare Advantage plan, you'll have to pay certain costs for your care. For example, the plan you select may have a monthly premium. You'll also be responsible for cost-sharing (copays or coinsurance) on medical services such as doctor office visits and prescription drugs. Your costs will vary depending on the plan you choose. For more details, refer to the Summary of Benefits or Evidence of Coverage.

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Financial Help

What kind of financial help is available?
Medicare provides assistance in paying for prescription drugs for individuals with limited income and resources. This assistance is called "Extra Help."

Do I qualify for Extra Help?
You may be able to get Extra Help to pay for your Medicare plan premiums and expenses, including prescription drug costs. Call 1-800-MEDICARE (1-800-633-4227) to see if you qualify. TTY/TDD users call 1-877-486-2048, 24 hours a day, 7 days a week. You can also call the Social Security Administration at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY/TDD users call 1-800-325-0778, or call your State Medicare Office.

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