Medicare Part D FAQ
Medicare Part D became effective January 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It is a prescription drug benefit provided by private insurance companies who have been approved by Medicare and contract with the federal government. United American Insurance Company has been approved by Medicare to offer this coverage.
Who is eligible for UA Medicare Group Part D?
Anyone enrolled in Medicare Parts A and/or B qualifies for Part D coverage. You may also qualify through a group program sponsored by your employer. You are entitled to this program regardless of your health history or the prescription drugs you take. If you have limited income and resources, you may qualify for extra help. Contact the Social Security Administration to see if you qualify at 800-772-1213.
What costs are covered under Medicare Part D?
Medicare Part D will cover costs for drugs that are available only by prescription, approved by the Federal Drug Administration (FDA), used and sold in the United States, and used for a medically accepted condition.
All Medicare Part D plans are required to cover generic and brand name prescription drugs, biological products, vaccines, insulin, necessary syringes, needles, alcohol swabs, and gauze. Medicare Part D does not cover drugs for anorexia, weight loss/gain, ED, fertility, and cold/cough relief. Also not covered are barbiturates, benzodiazepines, prescription vitamins, over-the-counter (OTC) medications, and cosmetics.
Where can I find general information about Medicare prescription drug coverage?
If you have general questions about Medicare prescription drug coverage, please call Medicare at 800-MEDICARE/800-633-4227 (TTY/TDD users: 877-486-2048), available 24/7. Or, visit www.medicare.gov.
Pharmacies
Where can I get my prescriptions filled?
UA Medicare Group Part D utilizes a network of preferred (participating) pharmacies. You need to use a network pharmacy to receive plan benefits. To find out if your pharmacy is in the network, call us toll-free at 866-524-4199 (TTY/TDD users: 866-524-4170), 8 a.m. to 8 p.m. in your time zone.
What is a network pharmacy?
A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by UA Medicare Group Part D prescription drug coverage. In most cases, your prescriptions are covered under our plan only if they are filled at a network pharmacy or through our mail order service. We will fill prescriptions at a non-network pharmacy under certain circumstances.
How do I fill a prescription at a network pharmacy?
To fill your prescription at a network pharmacy, you must show your UA Medicare Group Part D Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your copayment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call Customer Service.
How do I fill a prescription through UA Medicare Group Part D’s mail order pharmacy service?
To get order forms and information about filling your prescriptions by mail, please visit www.medco.com or call Medco Customer Service at 800-596-4645 (TTY/TDD users: 800-716-3231). Please note that you must use UA Medicare Group Part D’s mail order service. Prescription drugs that you get through any other mail order service are not covered.
You can use the UA Medicare Group Part D mail order service to fill prescriptions for “maintenance drugs.” These are drugs that you take on a regular basis for a chronic or long-term medical condition. Our formulary tells you which drugs we consider to be maintenance drugs. If you want to use our mail order service, ask your doctor to write a new prescription for up to a 90-day supply of medication, plus refills (as appropriate).
What if I need to fill a prescription while I am traveling and I am away from the plan’s service area?
If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time through our mail order pharmacy service.
Note: We cannot pay for any prescriptions that are filled by pharmacies outside of the United States (and territories), even for a medical emergency.
What will I have to pay if I go to an out-of-network pharmacy for one of the reasons listed above?
You will have to pay the full cost (rather than paying just your copayment) when you fill your prescription at an out-of-network pharmacy. You can ask us to reimburse you for our share of the cost by submitting a claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription.
When you go to a network pharmacy your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy because of the reasons listed above, the pharmacy may not be able to submit the claim directly to us and you will have to pay the full cost of your prescription. When you return home, simply submit your claim and your receipt to the following address: Medco Health Solutions, Inc., P.O. Box 14711, Lexington, KY 40512. Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Evidence of Coverage or call Customer Service for more information on initial coverage determinations.
More information
Where can I find more information about UA Medicare Group Part D?
Refer to your Evidence of Coverage and other plan materials to find additional information about your UA Medicare Group Part D prescription drug coverage. You can also contact UA Medicare Group Part D Customer Service at 866-524-4199 (TTY/TDD users: 866-524-4170), 8 a.m. to 8 p.m. in your time zone.
