Important News for Medicare
Part D Enrollees!

The NALC Plan prescription drug benefits will, on average, pay as much or more than the standard Medicare Part D prescription coverage. And as long as you keep the NALC Plan coverage, you do not have to immediately enroll in the Medicare program, but can do so in future open season enrollment periods without incurring a premium penalty.

If you elect to enroll in Medicare Part D prescription drug coverage, and Medicare is your primary plan, the NALC Plan will coordinate its benefits with Medicare Part D after Medicare has paid its share of the costs. Some Medicare plans may have mail order and retail benefits. The NALC Plan coordinates with both types of Medicare Plans. But when the NALC Plan is not your primary prescription drug plan, you are not using the NALC Caremark Mail Order program. Instead, we are paying after your Medicare plan on covered balances up to 85%. Here is how the standard Medicare Part D and the NALC Plan will work:

First, Medicare requires that you pay a $250 deductible by applying your covered prescriptions towards the $250. The NALC Plan will pay up to 85% of the drug costs applied towards Medicare's deductible or $212.50. You will ultimately pay $37.50.

After the deductible amounts have been incurred, Medicare pays 75% of your next $2,000 in covered prescription costs, or $1,500. For each covered prescription, the NALC Plan will pay the remaining balance by using its normal benefit allowance of 85%. In this way, the total $500 balance of covered charges not paid by Medicare are paid by the NALC Plan. Together, Medicare and the NALC Plan paid 100%, so you pay nothing on these $2,000 covered charges.

At this point you have now reached $2,250 in total covered prescription charges. Medicare Part D pays nothing until your out-of-pocket expenses total $3,600. During this period, if you obtained your prescription through an NALC Plan network retail pharmacy, the NALC Plan will pay up to 85% and you will pay 15%. If you do not use a NALC CareSelect Network retail pharmacy, we will pay only up to 50% of the covered charges. The balance after our payment goes towards your $3,600 Medicare out-of-pocket total.

Once you have met $3,600 in out-of-pocket costs, Medicare will begin paying for covered prescriptions at 95%. The NALC Plan will pay the 5% balance, not paid by Medicare. You pay nothing.

The NALC Plan encourages members to review their options carefully in order to determine if choosing Medicare Part D best suits your needs. Call us if you have any questions. We are here to help you.

NALC Health Benefit Plan 20547 Waverly Court
20547 Waverly Court
Ashburn, VA 20149
1-888-636-NALC (6252)