About the GHI Medicare Prescription Drug Plan

GHI is a health insurance company that offers a wide variety of health plans, including subsidized health plans for people on Medicare and for United States citizens with low income who do not qualify for Medicare but who are eligible for other subsidized health insurance. The GHI Medicare Prescription Drug Plan is a supplement to Medicare that covers prescription drugs for U.S. residents who meet income qualifications and guidelines.

Eligibility

• To qualify for GHI prescription drug coverage, you must be eligible for Medicare Part A and/or enrolled in Medicare Part B. In order to be eligible for Medicare, you must meet certain conditions. You or your spouse must have worked for 10 years or more for a Medicare-covered employer. You must be 65 years of age or older, or have a permanent disability or end-stage renal disease. And you must be a U.S. citizen.

  Eligible Medicare recipients may enroll in only one Medicare prescription drug plan. Enrollment is open at specified times throughout the year, and you must be on or eligible for Medicare during those enrollment dates.

  Those enrolled in Medicare Advantage Plans, Medicare Private Fee-For-Service Plans or Medicare 1876 Cost Plans are not eligible to enroll in the GHI Medicare Prescription Drug Plan. Medicare Advantage also covers prescription drugs.

Coverage

• The GHI Medicare Prescription Drug Plan covers drugs, vaccines, biological products and medical supplies that are covered under Part D of the Medicare Prescription Drug Plan. The drugs must be on the GHI Medicare plan's formulary list to be covered and must not be covered under Medicare Part B.

  The list is updated periodically to add, remove, change or limit coverage of certain medications. You may have a co-pay depending on the type of drug, and that co-pay is listed on the formulary. If the co-pay or coverage changes while you are on a drug, you will be notified before the change.

  If you are prescribed a drug that is not on the list of approved drugs, you may be able to request an exception or switch to an alternative listed drug. While you are waiting for an exception or a change, you may be entitled to receive a temporary supply of the drug if you or your physician contacts GHI to get approval in advance.

Where to Get Prescriptions

• The GHI Medicare Prescription Drug Plan has a wide variety of covered pharmacies. You must use an in-network pharmacy in order for your drugs to be covered. There are in-network pharmacies in all 50 states, and the cost and co-pay for drugs is the same no matter which in-network pharmacy fills your prescription.

  If you have your prescription filled at a retail pharmacy, you are entitled to purchase a 30-day, a 60-day or a 90-day supply. The co-pay varies depending on the supply, but it is generally more economical to purchase a larger supply.

  You also can receive your drugs from a long-term care pharmacy or a mail order pharmacy. If you choose to get drugs from a long-term care pharmacy, you must order a 30-day supply. If you use mail order, you can get a 30-day, a 60-day or a 90-day supply.

Premiums, Deductibles and Co-Pays

• The premiums for GHI prescription drug coverage are $19.60 each month. There is a $295 yearly deductible, which means you must pay for the first $295 of prescription medication each year. Once you meet this deductible, you will pay 25 percent of the cost of your medication until the total cost of prescriptions is $2,700.

  After that, you are responsible for 100 percent of the cost of prescriptions until those costs reach $4,350. After that, you are responsible for the greater of $2.40 for generic drugs and $6 for non-generic drugs, or a 5 percent co-pay.

  Some clients qualify for extra help with premiums or co-pay costs. Low-income clients, those living in long-term care facilities and those who use Indian or Tribal health services are generally eligible for additional help and/or have different co-pays and premiums. Medicare determines the amount of extra help based on income levels. You can call Medicare at 1-800-Medicare to determine the amount of assistance you will receive. GHI will have this information available at the time of enrollment and alert you to your actual premium and co-pay responsibilities.

Limitations

• The GHI Medicare Prescription Drug Plan may require you to try approved drugs, or select drugs, before it will cover alternate treatments for a given medical condition.

  Some drugs have quantity limitations and will be covered only to a certain quantity.

  With some drugs, your doctor must call GHI to receive approval before prescribing. If your doctor does not get authorization, GHI may refuse to cover the prescribed treatment.