Medicare Plan Changes

Changes to the Medicare plan effective July 1, 2017.

MEDICATION-ASSISTED TREATMENT
There will no longer be any copayments or prior authorization for Medication-Assisted Treatment for opioid use disorder (generic buprenorphine-naloxone, naloxone, and naltrexone products).

HARVARD PILGRIM MEDICARE ENHANCE, HEALTH NEW ENGLAND MEDPLUS, AND TUFTS MEDICARE COMPLEMENT

  • The prescription drug programs for these plans will change to an Employer Group Waiver Plan (EGWP) with CVS’s SilverScript. 
    • Your plan will include Medicare Part D effective July 1, 2017.  Do not enroll in a non-GIC Medicare Part D Plan.
    • You will receive a federal government-required opt-out mailing early May.  Do not opt out of the SilverScript Part D program.  If you do, you will lose your GIC health, behavioral health, and prescription drug benefits and will not be able to re-enroll until next spring.
    • If you have extremely limited income and assets, contact the Social Security Administration to find out about subsidized Part D coverage.
    • If your adjusted gross income, as reported on your federal tax return, exceeds a certain amount, Social Security will impose a monthly additional fee called IRMAA (Income-Related Monthly Adjustment Amount).  Visit Medicare.gov for more information. Social Security will notify you if this applies to you.
  • The copay for physician office visits, retail clinic/urgent care, outpatient behavioral health/substance use disorder care, physical therapy, occupational therapy, speech therapy, and routine eye exams will increase to $15 per visit.

FALLON SENIOR PLAN AND TUFTS MEDICARE PREFERRED

  • The copay for physician office visits; retail clinic/urgent care; and outpatient behavioral health/substance use disorder care will increase to $15 per visit effective January 1, 2018.

UNICARE STATE INDEMNITY PLAN/MEDICARE EXTENSION (OME)

  • The $35 calendar year deductible will be eliminated.
  • There will be a $10 per visit copay for physician office visits, retail clinic/urgent care, and outpatient behavioral health/substance use disorder care.
  • The copay for Emergency Room care will increase to $50 per visit.
  • The $100 deductible for out-of-network behavioral health has been eliminated.

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