We understand that the world of prescription drugs and Medicare can be confusing. We want to help provide information to ensure you understand all the options that are available to you under Medicare. Granite Alliance is an Employer Group Waiver plan, and is Medicare approved to cover your prescription drugs.
Medicare Part A is generally known as
Hospital Insurance. Usually there is not a premium associated with Part A
(unless you/or a spouse have not paid into Medicare for ten years). Part A does
have a deductible and other cost-sharing that is applied.
Some key coverages under Part A include Hospital Rooms, Inpatient Acute Care, Inpatient Mental Health, Skilled Nursing Facility, and Home Health care.
Medicare Part B is your Medical insurance
covering a variety of services outside of an Inpatient Hospital stay. This premium
is taken directly from your Social Security check and paid directly to
Medicare. There are also deductibles and coinsurances that apply with Part B.
Services covered under Part B include Doctor visits, Annual Wellness visits, Outpatient Services, Clinical labs, Medical Supplies, X-rays, MRIs, and CTs.
Medicare Part C is referred to as “Medicare Advantage” plans. They replace Medicare Parts A and B, and sometimes include Part D coverage. They cover the same benefits that are in Parts A and B (Hospital and Outpatient services). Many also offer additional benefits including dental, eyewear, and more. When you are enrolled in a Part C plan, you still pay your Part B premium, and generally an additional premium for the Medicare Advantage plan. These plans are offered by private insurers who are paid directly by the federal government.
Medicare Part D offers prescription drug coverage. Granite Alliance is a Medicare Part D plan and will cover outpatient prescription medications. The medications that are covered are shown on your drug list – also known as a formulary. The pharmacies that can be used are listed in your pharmacy directory. These plans are offered by private insurers who must have approval by Medicare to offer coverage.
Medicare Supplement plans – also known as Medigap – work along with your Medicare Parts A and B. The Medigap plan will cover the cost sharing gaps on your Medical coverage, such as your copays or coinsurance. These do not include Part D prescription benefits.
An Employer Group Waiver Plan (EGWP), or “Egg Whip”, is a group Medicare Part D prescription drug plan which gives the employer an opportunity to provide group benefits to their Medicare-eligible populations. Think of EGWPs are specialized PDP products to which only employees of a company can join. Your Granite Alliance plan is an EGWP plan. To learn even more about the value of your EGWP plan please visit our Learn More page.
Now that you understand the basic plan options that are available to you, lets discuss the various enrollment timeframes that might be available to you. Please note that you must enroll in Granite Alliance coverage directly through your employer.
Both U.S citizens and legal residents are eligible for Medicare. If you are a legal resident you must have lived in the U.S. for at least 5 years in a row. You must also meet one of the following requirements:
There are several different enrollment periods which allow you to enroll into Medicare. You may not need some of these enrollment options if you are enrolled in Granite Alliance, however it is important to understand they are available to you.
Initial Enrollment Period: This is the “main” enrollment into Medicare and occurs when you’re turning 65. You are eligible to enroll three months before your birthday, during your birthday month, and the three months following your birthday. We recommend signing up once you are eligible, otherwise you can face penalties and pay higher premiums. This is known as the “Late Enrollment Penalty”.
General Enrollment Period: If you miss your initial enrollment period, you may also enroll from January 1 to March 31 each year (into Part A and/or Part B).
Annual Enrollment Period: Every year Medicare establishes that you can make changes to your coverage from October 15th to December 7th. Your employer may also set up a separate Annual Enrollment Period for your EGWP coverage over different dates. You can change your Part C or Part D coverage during this time. Prior to your annual enrollment period each year we will send you materials explaining the benefits for the upcoming plan year so you can have a full understanding of your prescription drug coverage. The changes you make during this time will go into effect starting January 1st.
Special Enrollment Period: You may qualify for a special election period where you can enroll, or change coverage, outside of the standard enrollment periods. There are several different qualifications, with the most common being if you move out of your plans service area or if you lose existing insurance coverage (such as with an employer).
We strongly recommend enrolling in prescription drug coverage when you are eligible, or you may be subject to a “Late Enrollment Penalty” being assessed by Medicare. This penalty will be applied if you do not sign up for a plan within 63 days of your Initial Enrollment Period, or if you ever go a timeframe of more than 63 days without credible prescription drug coverage (such as employer coverage).
During the year you will pay different amounts for your medications, depending on what stage of coverage you are in. Your plan, Granite Alliance, will keep track of your costs throughout the year and move you through the different stages. Each month you will receive an Explanation of Benefits (EOB) that show your costs for the previous month, and indicates what stage you are currently in. The stages “reset” each year and you start over on January 1st.
There are four different stages established by Medicare. Please note, the dollar amounts listed below may vary slightly for your Granite Alliance benefit. We recommend reviewing your Evidence of Coverage for information specific to your coverage.
There are resources available to help with the costs that come with Medicare coverage – including premiums, deductibles, copays, and coinsurance.
Information about these services can be found by reviewing the following resources:
Do you have additional questions about your Medicare coverage? There are many resources available to help you.
Last Updated Date: 1/10/2023
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