23 Q.  Can I cancel my WSSC coverage before 2018 and enroll in a standard Medicare Part D Prescription Drug Plan that is not offered by WSSC? A. You should not enroll in an individual Medicare Part D plan on your own if you wish to be covered by the WSSC plan. If you enroll in a Medicare Part D plan on your own, your coverage through WSSC will automatically be cancelled because the Federal government does not allow coverage under two Medicare Part D plans. The WSSC plan includes a second component that will provide benefits above and beyond the standard government-approved Medicare Part D prescription benefits to help maintain current coverage levels (i.e., the “Wrap”). The ben- efits of this second component will not be available to you if you enroll in a plan not offered through WSSC. In addition, since the prescription drug coverage is linked to your health insurance election, a decision to cancel your prescription drug coverage will also cancel your medical coverage. WSSC will take the necessary steps to enroll new Medicare-eligible members in the SilverScript plan. The change will be automatic if you are eligible for Medicare, are enrolled in Medicare Parts A and/or B, and have prescription coverage through WSSC (excluding Kaiser). Premiums and Subsidies Q. Is there a subsidy available for low income retirees? A.  Yes, under certain circumstances, covered members may be eligible for a Low Income Subsidy. Low income status is determined by either the Social Security Administration (SSA) or the State Medicaid office. Generally, those eligible include individuals with income less than 150% of Federal Poverty Level ($18,090 for single persons in 2017) and with total resources less than $13,820 (for single persons in 2017). For more details, visit the SSA website at www.socialsecurity.gov, or call 1-800-772-1213 (TTY 1-800-325-0778). Q. Can you explain the extra amount high income retirees are required to pay? A.  Medicare Part D requires that Part D plan participants who are determined to be high income retirees be charged an Income Related Monthly Adjustment Amount or “IRMAA.” This IRMAA charge will apply because SilverScript is a Medicare Part D plan. The SSA determines who is considered a high income retiree based on tax status and yearly income as reported on IRS tax returns from two years ago. The IRMAA charge will be deducted directly from the member’s Social Security check. In some instances, the SSA will bill affected retirees directly. To keep their coverage, high income retirees in the SilverScript plan must pay this amount to SSA. In 2018 monthly IRMAA charges range from $13.00 to $74.80 per person and are based on modified adjusted gross income (MAGI). Plan Benefits Q. Can I use a retail pharmacy other than a CVS pharmacy? A.  Yes, you may use one of the over 68,000 participating pharmacies currently available to you such as Giant, Walgreens and Walmart. Q. Will I still be able to save money by using Maintenance Choice for my maintenance medications? A.  For maintenance medications (long-term medications taken regularly for chronic conditions, such as high blood pressure, high cholesterol or diabetes, or long-term therapy), you may fill up to a 90-day prescription at either a CVS pharmacy retail location or through CVS/caremark Mail Service Pharmacy and pay the mail order copay for up to a 90-day supply. In addition, you may fill a 90-day prescription at a retail pharmacy other than a CVS pharmacy, however, your total copay will equal three 30-day copays. Q. Is there a different formulary for SilverScript? A.  No. Like today, you will use the CVS/caremark Preferred Drug List (PDL). However, the Medicare Part D part of SilverScript also uses a CMS formulary; you may receive CMS required mailings regarding this formulary stating that certain drugs are not covered. In most cases you may disregard these CMS letters because the wrap feature of the WSSC plan will pick up coverage of those medications because it uses the same, more comprehensive formulary. SilverScript Prescription Drug Coverage (cont’d) If your filing status and yearly income in 2016 was: File individual tax return File joint tax return File married & You pay monthly separate tax return (in 2018) $85,000 or less $170,000 or less $85,000 or less your plan premium above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $13.00 + your plan premium above $107,000 up to $160,000 above $214,000 up to $320,000 not applicable $33.60 + your plan premium above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 up to $129,000 $54.20 + your plan premium above $214,000 above $428,000 above $129,000 $74.80 + your plan premium