Medicare Plan Benefit Changes Effective July 1, 2015

Rules for Enrolling in Health Plans and Adding Dependents: In compliance with federal and state law for pre-tax benefits, the GIC will be tightening up our rules and instituting deadlines for enrolling in health plans and adding dependents.  As always, required documentation (e.g., birth certificates and marriage certificates) must accompany the change forms. See Modifications to Rules for Enrolling and Changing Plans for additional information. 

Prescription Drug Copays: All prescription drug copays except for Tier 1 retail will increase to: Tier 2 $30 and Tier 3 $65 retail up to a 30-day supply; Tier 1 $25; Tier 2 $75 and Tier 3 $165 mail order up to a 90-day supply. For Fallon Senior Plan and Tufts Medicare Preferred, these changes will go into effect January 1, 2016.


  • Prescription Drug Program:  CVS/caremark was selected to continue as the pharmacy benefit manager.  Prior authorization will be required for certain high-cost drugs.  See the Prescription Drug page for more information.

Certain Oral, Injectable, Infused and Inhaled Specialty Drugs:  After the first fill of certain specialty drugs, you must get refills through CVS/caremark’s specialty pharmacy. The first fill may be limited to up to a 14-day supply with a prorated copay.

Prescription Drug Program Will Become an Employer Group Waiver Plan (EGWP) Effective January 1, 2016: The prescription drug benefit will transition to an EGWP Program, a Medicare Part D plan, with additional coverage provided by the GIC.  Members of UniCare State Indemnity/Medicare Extension and their Medicare-eligible spouse and dependents will automatically be enrolled. 

Under this program:

  • Low income retirees may be eligible for subsidies and reduced copayments; 
  • The Medicare Part D premium is included in your monthly health insurance rate. However, enrollees deemed by Social Security to have high income will also pay an Income Related Monthly Adjustment Amount (IRMAA) for Medicare Part D.  Visit Social Security’s or Medicare’s website for more information;  
  • Benefits of the plan will match or be similar to the UniCare Non-Medicare health plan drug program;
  • Because of the additional coverage provided by the GIC, your coverage will be better than a standard Medicare prescription drug plan; and
  • You will have more retail pharmacy options for filling your 90-day maintenance medications. 

We will send you additional details about the EGWP Program in the late summer; for Annual Enrollment, you do not need to do anything if you want to stay in this health plan.

This information provided by the Group Insurance Commission .