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Retirees - Medicare in the US

Retirees: Medicare in the US
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Medicare is the hospital and medical insurance program sponsored by the US Government. Once members of the IDB Group Medical Benefit Program become eligible members of Medicare Part B, coordination of benefits between both programs start to take effect. Medicare becomes the primary insurer and the IDB Group Medical Benefit Program the secondary insurer.  

Enrollment in Medicare Part B is mandatory for participants of the IDB Group Medical Insurance Program at age 65. The plan reimburses the cost of the Medicare Part B premium to eligible participants.  

P&A Group handles Medicare Part B reimbursements for enrolled participants and their eligible dependents on behalf of the IDB.

Medical Benefits Program pharmacy benefits are provided through Medicare Part D for Medicare members with minimal changes to the pharmacy experience besides a) a different Express Scripts Customer Service number b) no out of network pharmacy access and c) the Medicare TrOOP program, that may limit our members annual prescription drug spend.

Medicare FAQs Medicare Overview
Who is eligible for Medicare Part B
  • US citizens 
  • Qualified by residence (if you have lived in the US for 5 years in a row) 
  • Qualified by age (65) and by marriage 
  • US Permanent Resident (the time spent as a G4 Visa holder prior to becoming a permanent resident counts toward the 5-year residency requirement to be eligible for Medicare Part B) 
Reimbursement Process

To receive reimbursement, you must send a copy of the letter with your premium amount from the Social Security Administration or the Notice of Medicare Premium Bills from the “Centers of Medicare & Medicaid Services” (CMS) to the P&A Group at these times:

  • When you are first starting Medicare, please send your Medicare card for registration at HRD/INS@iadb.org. IDB will send your registration to P&A Group and then advise you when you can send your first request for reimbursement.

  • Every December thereafter as you will receive a new Notice of Medicare Premium Bills or a letter from Social Security Administration from the “Center of Medicare & Medicaid Services that indicates your upcoming year’s Medicare Part B premium

For the annual update, to ensure your reimbursement is issued by January, please submit all necessary documentation to the P&A Group by the previous December 21st. The P&A Group will process all reimbursement requests submitted after 12/21 as soon as possible but cannot guarantee they will be issued by January 21st. To receive your monthly premium reimbursement on a timely basis, please follow these instructions:

  1. Please do not submit your claim reimbursement form/request with supporting documentation for more than one (1) individual at a time. Each claimant must have their own P&A Group account and submit their own reimbursement request separately. 
  2. If a reimbursement request is received for more than one (1) individual at a time, you may not be issued a reimbursement.
  3. Each reimbursement request must include the P&A Group claim form (2024) AND the corresponding documentation.
  4. The name of the individual on the P&A Group claim form must match the name of the individual listed in the supporting documentation. If there is a mismatch in the data provided, the reimbursement request cannot be processed.
  5. Your Medicare Part B premium reimbursements will be scheduled to be sent via electronic deposit to the bank account where the IDB deposits your pension.
  6. Please upload, scan, fax or mail the required documents as follows: 
  • Online Reimbursement Request: – Enter your reimbursement request online through the P&A Group website at www.padmin.com. Create an account or login to your existing account and select “Upload a Claim” (Medicare Part B reimbursement request) under the Members Tools tab.
  • Mail or Fax - Complete a P&A Group reimbursement request claim form and fax or mail with supporting documentation to:

Fax: Toll- free (855) 362-7711

Mail: The P&A Group

Flex Department

Attn: IDB Group Premium Reimbursement

6400 Main Street, Suite 210 

Williamsville, NY 14221

Finally, in accordance with Article 12 of PE-333, if you are a Medicare Part B participant, you must submit your premium reimbursement claims to the P&A Group within 24 months of the date of the invoice with proof of payment attached. Unreimbursed Medicare Part B premium claims older than two (2) years will lapse and become ineligible for reimbursement.

If you have additional questions, you may contact the P&A Group directly at (716) 463-2541; visit the retiree website; or the email Wellbeing and Health Benefits team at HRD-INS@iadb.org or call 202-623-3137.

Information about the P&A Group
  • Online account to manage and monitor your reimbursements. 
  • Online access to your account 24/7 at www.padmin.com (it is not mandatory to create account). 
  • Step by step on how to access your benefits 
  • Customer Service Monday to Friday, 8:30 am to 8:00 pm EST. 
  • Email account notifications on refund status and other information. 
  • Online refund premium request. 
Medicare Part D “EGWP” Prescription Drug Plan for Medicare Members

If you are an IDB Medicare participant, your prescription drug coverage is provided through Express Scripts Medicare (Prescription Drug Plan). Members may also see terms such as an employer-sponsored Part D plan, PDP, Employer Group Waiver Plan, or “EGWP” in communications from Express Scripts. 

How does this compare to the prescription drug coverage offered by the Medical Benefits Program for non-Medicare members? 

  • The covered medications are the same: All medications covered under the non-Medicare  plan are covered as well as medications that are not covered by Medicare as Part D drugs. There is also a broader formulary that includes additional medications.  
  • Minimal changes to plan design: Copays for each drug tier are the same. However, some medications are in a different tier than the non-Medicare plan, so there may be a $15 increase or decrease in the applicable copays. The only benefit difference is that there will only be coverage for out of network pharmacies for emergency situations. 

True Out-of-Pocket Maximum (TrOOP)

Medicare uses a True Out-of-Pocket Maximum (TrOOP) to cap member out-of-pocket annual prescription drug costs at $2,000. All of the Medicare Part D copays plus a portion of the cost that the Medical Benefits Program pays for Medicare Part D prescriptions go towards this annual cap. Once the TrOOP cap is hit, members will no longer pay copays for Medicare Part D prescriptions for the rest of the year. As a result, this new TrOOP may reduce the annual out of pocket expense for prescription drugs. Members receive a monthly Explanation of Benefits every month you fill a prescription with this information; and it will be available on the Express Scripts mobile app and website. 

Express Scripts Special Customer Service Number for Medicare Part D

If you have any questions about your coverage or prescriptions, you can contact Express Scripts Medicare Customer Service at the number on the ID card: 1.877.777.8365 or 1.800.716.3231 for TTY users. Customer service is available 24 hours a day, 7 days a week. 

Additional Information

Benefit Overview 

Welcome Kit Introductory Letter

Welcome Kit from Express Scripts

Medicare Part D Formulary

INS Team Webinar about Medicare Part D/EGWP 

Detailed FAQs 

Multiple Express Scripts Account Instructions

Part D Administrative Programs

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