New Medicare Prescription Options for Retirees and Vision Coverage
RE: New Medicare Retiree Prescription Plan with United Healthcare
Dear Brother and Sister Retirees:
By now you should have received information from Transit and United Health Care regarding a new prescription plan for Medicare retirees. This program is known as Employee Group Waiver Plan (E.G.W.P).
The United Healthcare Prescription plan is an additional option to Medicare retirees. If you wish, you may opt out by simply calling 1 (866) 846-9961. Members who opt out will remain in the current Optum RX prescription plan. If you do not call and opt out you will be automatically enrolled in the United Healthcare RX plan.
Why did Transit create this plan? To save money. The Affordable Care Act provides a subsidy by drug manufacturers and makes Medicare Part D plans more attractive for employers such as New York City Transit. We in Local 100 are working to ensure that no retiree will suffer any loss by electing this plan.
What about member costs, and the medi-gap or doughnut hole? If you choose to go into the new plan, you will be protected both by our collective bargaining agreement and Medicare regulations. Even though the drug coverage will be under the Medicare Part D plan, your coverage and cost will be the same. All drugs currently covered are still covered and no drug will become more expensive; a few drugs will become less expensive. Transit will fully cover the costs of the doughnut hole so that your costs will not change.
All currently participating pharmacies will continue to be in the network. The only exception is Veterans Administration pharmacies, where members may use their VA or Tri-care cards to obtain medications.
What might be the advantages of the new plan?
Mail order will no longer be required. Although there might be a small savings by filling your prescriptions through the mail order, enrollees in the new plan will now have a choice of either using mail order or going to a local pharmacy to fill their prescriptions.
Members of the new plan will receive an explanation of benefits each month.
Currently, under the Optum RX plan, members who have AETNA option 1, pay 50% cost of the prescription. The new plan caps their Non-Formulary medications at 50% cost of the prescription or $ 95.00, whichever is lower.
Also, certain medications such as Celebrex and Enbrel that are classified as Non-Formulary cost the member $ 15 a month. These same drugs are classified as Formulary under the United Healthcare Rx and the cost is only $10.00 a month.
Our job at the Union is to protect the current level of benefits and make improvements where we can. Local 100 is working to ensure that no member loses anything if they choose this plan. We expect it to be a useful option for our members.
Our vision plan only pays a minimal amount for an eye exam, frame and lenses (see table below). In order to get the best deal on glasses possible, and to ensure you get a quality eye exam, we recommend that our UHC and Aetna members* get an eye exam through a participating doctor or optometrist in their health plan, and then go to get their glasses using the vision plan.
*note – Routine eye exams are not covered for members covered by Blue Cross / Blue Shield.
VISION SERVICE SCHEDULED PAYMENT MAXIMUM
Complete Optometric Examination* $15.00
Single Vision Lenses and Frames (Exam Included) $37.44
Kryptok Bifocal Lenses and Frames (Exam Included) $69.12
Trifocal Lenses and frames (Exam Included) $72.00
* In New York State, vision centers provide both eye examinations and eyeglasses. In New Jersey, current law forbids vision centers to have facilities for optometric examinations. Under the Vision Plan, you will be reimbursed according to the schedule, no matter what vision center you use.