Compass Rose
Health Plan

Your partner in health

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Medicare Basics

 

Medicare is a health insurance program for:

  • People 65 years of age or older
  • People under 65 with certain disabilities
  • People of any age diagnosed with End-Stage Renal Disease (ESRD) - permanent kidney failure requiring dialysis or a kidney transplant

Three months prior to your 65th birthday, the United States Social Security Administration will notify you about your upcoming benefits available through Medicare. If you choose to enroll, your coverage becomes effective the FIRST day of the month you turn 65.

Medicare has four parts:

    • Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospices and home health care. Most people are not responsible for paying Part A premiums because they paid Medicare taxes while working. If you or your spouse worked for at least 10 years in a Medicare-covered position, you should be able to qualify for premium-free Medicare Part A insurance.
    • Medicare Part B helps cover a portion of medically necessary services (i.e. doctors' services, outpatient care, home health services and other medical services not covered by Medicare Part A). Part B also covers some preventive services. Coverage is voluntary and requires payments for premiums, deductibles and coinsurance.

      If you choose NOT to enroll in Medicare Part B when you first become eligible, you may be charged a Part B late enrollment penalty, resulting in a 10% increase in premiums for every 12 months you are not enrolled.
    • Medicare Part C Advantage Plans are private health care choices (HMOs and regional PPOs) in selective areas of the country. For more information regarding Medicare Part C Advantage Plans, please contact a Medicare Representative at (800) 633-4227.
    • Medicare Part D helps cover the cost of prescription drugs.

      The Office of Personnel Management (OPM) determined that the Compass Rose Health Plan's prescription drug coverage is, on average, expected to pay out as much as the standard Medicare Prescription Drug Coverage will pay for all plan participants and is considered creditable coverage.

How We Work With Medicare

 

Being enrolled in Medicare and the Compass Rose Health Plan can help significantly decrease your out-of-pocket health care costs. Even though enrolling in Medicare is not required, there are some definite advantages to having BOTH Medicare and the Compass Rose Health Plan.

Below is a list of covered benefits available when you enroll in both Medicare Part A and Part B and the Compass Rose Health Plan.

Inpatient Hospital Care Expenses: Upon turning age 65, most Federal employees and annuitants are entitled to Medicare Part A at no additional cost. If you are not responsible for paying premiums, we strongly encourage you to obtain Medicare Part A. As your secondary insurer, we will waive your hospital co-pays and coinsurance.

Outpatient Provider Expenses: If you are enrolled in Medicare Part B, as your secondary insurer we will waive your calendar year deductible, most co-pays and coinsurance for medical services and supplies provided by physicians and other health care professionals.

Prescription Drug Coverage: If you are enrolled in Medicare Part B, as your secondary insurer we offer lower co-pays for your prescription drugs.


Level IN-NETWORK RETAIL PHARMACY
(30-DAY SUPPLY)
HOME DELIVERY
MAIL-ORDER 
(90-DAY SUPPLY)
TIER 1 
(GENERICS)
$3 co-pay* $6 co-pay*
TIER 2 (FORMULARY/
PREFERRED BRAND NAME)        
$18 co-pay* $36 co-pay*
TIER 3 
(NON-FORMULARY/
NON-PREFERRED 
BRAND NAME)
$35 co-pay or 30%,
whichever is greater*
$45 co-pay or 30%,
whichever is greater*            

SPECIALTY PHARMACY IN-NETWORK RETAIL PHARMACY
HOME DELIVERY
MAIL-ORDER 
(30-DAY SUPPLY)
GENERICS
N/A 20% up to a maximum of $150*
FORMULARY/
PREFERRED BRAND NAME         
N/A 20% up to a maximum of $200*
NON-FORMULARY/
NON-PREFERRED 
BRAND NAME
N/A 25% up to a maximum of $300* 

* No deductible applied.


Network of Physicians and Hospitals: Once you are enrolled in Medicare Part B, you have the freedom to be seen by ANY participating Medicare provider whether PPO, non-PPO, or out-of-network WITHOUT penalty. Visit medicare.gov to verify whether your provider participates in Medicare.

Other Covered Services: With Medicare Part B, you are also covered if you require diabetes testing supplies, respiratory supplies and medications, immunosuppressive medications, and oral anti-cancer medications. In addition, the Compass Rose Health Plan covers up to $1,200 for one hearing aid per ear every three (3) years (from date of service) for Medicare Part B members. Those without Medicare Part B will be covered up to $1,200 for one hearing aid per ear every five (5) years (from date of service).


Learn more about the benefits of Medicare

Our guide helps you understand how Medicare and your Federal Employee Health Benefits Plan work together.


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