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 |
NETWORK RETAIL
PHARMACY
(30-DAY SUPPLY) |
SMART90 RETAIL
PHARMACY
(90-DAY SUPPLY) |
HOME DELIVERY
MAIL-ORDER
(90-DAY SUPPLY) |
TIER 1
(GENERICS) |
$3 co-pay* |
$6 co-pay* |
$6 co-pay* |
TIER 2 (FORMULARY/
PREFERRED
BRAND NAME) |
$25 co-pay* |
$50 co-pay* |
$50 co-pay* |
TIER 3
(NON-FORMULARY/
NON-PREFERRED
BRAND NAME) |
$50 co-pay or 35%,
whichever is greater* |
$100 co-pay or 35%,
whichever is greater* |
$100 co-pay or 35%,
whichever is greater* |
SPECIALTY PHARMACY |
NETWORK RETAIL
PHARMACY
(30-DAY SUPPLY) |
SMART90 RETAIL
PHARMACY
(90-DAY SUPPLY) |
HOME DELIVERY
MAIL-ORDER
(30-DAY SUPPLY) |
GENERICS
|
N/A |
N/A |
10% up to a maximum of $100* |
FORMULARY/
PREFERRED
BRAND NAME |
N/A |
N/A |
25% up to a maximum of $250* |
NON-FORMULARY/
NON-PREFERRED
BRAND NAME |
N/A |
N/A |
35% up to a maximum of $500* |
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 in- 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).