Prescription Drug Coverage for Medicare-Eligible Retirees
The current NEI Health Benefit Plan prescription drug coverage for Medicare-eligible retirees will change effective January 1, 2025. On that date, you will be automatically enrolled in the Express Scripts Medicare Prescription Drug Plan (PDP). Your Medicare-eligible dependents currently enrolled in the NEI Health Benefit Plan will also be enrolled in the new program.
For detailed information about this change, please review the following documents:
Why is my prescription drug coverage changing?
As prescription drug costs continue to increase, the Trustees continue to look for ways to provide the highest possible quality coverage at the best price. With the change to the Part D Express Scripts Medicare PDP, the Health Benefit Plans will see an overall cost savings, and you, along with your Medicare-eligible dependents, will benefit from an annual cap on out-of-pocket costs.
Eligibility
Medicare-eligible retirees, Medicare-eligible spouses and other dependents of retirees, and Medicare-eligible surviving spouses who are enrolled in the NEI Health Benefit Plans are affected by this prescription drug coverage change.
Non-Medicare-eligible retirees, non-Medicare-eligible spouses, and non-Medicare-eligible dependent children who are enrolled in the NEI Health Benefit Plans are not affected by this change.
Retirees who are not yet Medicare-eligible on January 1, 2025, will be automatically enrolled in the Express Scripts Medicare Prescription Drug Plan (PDP) on the date they first become Medicare-eligible.
What is my new coverage?
The chart below shows what you will pay for covered prescription drugs under the new Express Scripts Medicare PDP. You can fill your covered prescription drugs at a network retail pharmacy or through Express Scripts home delivery service. Beginning January 1, 2025, please visit express-scripts.com, or call Express Scripts Medicare Customer Service for more information.
| Retail Pharmacy 30-Day Supply | Retail Pharmacy 90-Day Supply | Express Scripts Pharmacy Home Delivery 90-Day Supply | |
|---|---|---|---|
| Generic drugs | 20% coinsurance ($5 minimum / $40 maximum) | $10 copayment | $10 copayment |
| Preferred brand-name drugs | 20% coinsurance ($15 minimum / $40 maximum) | $30 copayment | $30 copayment |
| Non-preferred brand-name drugs | 20% coinsurance ($30 minimum / $40 maximum) | $50 copayment | $50 copayment |
Once you reach an annual limit of $2,000 in out-of-pocket costs, the Plan will pay for your medication on your behalf for the remainder of the year.
The Medicare Part D premium
Once you’re enrolled in the Express Scripts Medicare PDP, the monthly premium you pay to maintain Retiree health coverage through the Plan will not change, and your standard Part D premium will be paid through the Express Scripts Medicare PDP. However, Medicare may assess a monthly Medicare Part D Income Related Monthly Adjustment Amount (Part D-IRMAA) surcharge.
For 2025, you will be assessed a Part D-IRMAA surcharge if your taxable income in 2023 was more than $105,000 (or more than $210,000 if you and your spouse filed your taxes jointly).
For most retirees who are assessed a Part D-IRMAA surcharge, the surcharge will be deducted directly from their monthly Social Security check. However, the Trustees are adding a Reimbursement Program to help cover the surcharge.
Medicare Part D-IRMAA Reimbursement Program
Beginning in 2025, if you pay Part D-IRMAA surcharges during the calendar year, you may be eligible for reimbursement from the Plan through the Plan’s Medicare Part D-IRMAA Reimbursement Program, established by the Plan’s Trustees.
Eligibility for the Part D-IRMAA surcharge reimbursement is determined by the Plan each calendar year. You must submit a new Part D-IRMAA Surcharge Reimbursement Claim Form and updated proof of Part D-IRMAA surcharge each calendar year in order for the Plan to reimburse you for Part D-IRMAA surcharges for that calendar year.
How to claim your Part D-IRMAA surcharge reimbursement
As soon as you receive notice that you will be assessed monthly Part D-IRMAA surcharges for a calendar year, you should submit the following to the Benefits Office:
- A Part D-IRMAA Surcharge Reimbursement Claim Form
- Proof of the Part D-IRMAA surcharges you paid during a calendar year. Acceptable proof may be:
- A copy of the cost-of-living adjustment (COLA) letter sent to you by the Social Security Administration, or
- A letter you received from the Centers for Medicare & Medicaid Services (CMS).
Your proof must include your name and the monthly amount of the Part D-IRMAA surcharge.
Note that documentation received after December 31 of the calendar year in which you were assessed Part D-IRMAA surcharges may not be accepted.
A separate Part D-IRMAA Surcharge Reimbursement Claim Form must be submitted for each individual who is assessed Part D-IRMAA surcharges.
For example, if you and your Medicare-eligible spouse are both covered by the Plan and are both assessed Part D-IRMAA surcharges in 2025, you both must submit to the Plan a Part D-IRMAA Surcharge Reimbursement Claim Form and proof of Part D-IRMAA surcharges.
If you have any questions about the Part D-IRMAA surcharges, contact Social Security at 800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday, to speak with a representative.