Chronic Renal Disease Program
and Medicare Part D
If I have CRDP, why should I enroll in Part D?
Under Federal regulations, Medicare beneficiaries have only 63 days to enroll in creditable coverage or Medicare Part D from the day they are initially eligible for Part D. Those who are eligible and do not enroll timely are assessed a lifetime monthly late enrollment penalty by Medicare.
Creditable coverage is defined as coverage as good as or better than Medicare Part D. Since CRDP drug coverage is not deemed as creditable coverage by Medicare, CRDP cardholders who become Medicare eligible must elect Medicare Part D or creditable coverage. CRDP cardholders who do not enroll in Medicare Part D timely, may be assessed a lifetime late enrollment penalty.
Enrolling in Part D may also help to reduce out-of-pocket costs for medications not currently covered by CRDP. Individuals who are Medicare eligible and enroll in Medicare Part D helps incur less costs to CRDP. Lessening the CRDP’s portion of drug costs helps to expand benefits in the future.
Can I decide not to enroll in Part D at all?
Yes. Enrollment in Medicare Part D is voluntary if you are enrolled in CRDP. If you are in CRDP and you choose not to enroll in Part D, CRDP will continue to pay for your medications. However, if you lose CRDP coverage and need to enroll in Medicare Part D or if you decide to enroll in Part D later, you may be assessed a higher monthly premium because CRDP is not considered "creditable coverage."
Did all CRDP cardholders get selected for Part D?
No. CRDP enrolled cardholders into Part D if they were eligible for Part D coverage and had not yet enrolled in Part D on their own. Cardholders who have creditable coverage through an employer or retiree plan or who are enrolled in a Medicare Advantage plan (Medicare HMO) should not have been enrolled by CRDP into a stand-alone Part D plan. If you are a CRDP cardholder whose enrollment into a Part D plan negatively affected any other healthcare coverage that you have, please contact the program at 1-800-225-7223.
How do I know if CRDP is enrolling me in Medicare Part D?
If CRDP enrolls you into a Part D plan, you will receive a letter from the program telling you the name of the Medicare Part D plan that they have selected for you. If you did not receive a letter, you would not have been auto-enrolled into a Part D plan by the CRDP.
If you are enrolled in a Medicare Advantage plan (HMO) or have creditable coverage through your employer-sponsored retiree plan, CRDP will not enroll you into a stand-alone Part D plan. In this instance, if you have creditable coverage, it is considered as good as or better than Medicare and you may remain in that plan instead of enrolling in Medicare Part D. CRDP enrolled you in Part D, it would disrupt your health insurance or cause you to lose coverage completely. If you have either of these coverages, you should contact your insurance company for further instructions on whether you should enroll in Part D.
I have not received any letter or other information from CRDP about how they will work with my Part D plan. Does that mean that I will not get any help from CRDP with Part D costs?
All Medicare Part D plans are required to coordinate with CRDP for the purposes of prescription drug claims. Ultimately, prescriptions for Medicare Part D covered drugs that are also on the CRDP formulary will result in the lowest out-of-pocket expense at the pharmacy.
All Medicare Part D plans are NOT required to coordinate with CRDP for the purposes of premiums. To maximize the help received with premiums, each year, CRDP submits premium assistance agreements to Part D plans in Pennsylvania. Part D plans that meet the requirements of the Commonwealth subsequently become premium assistance plans. CRDP cardholders enrolled in a Medicare Part D plan without a premium assistance agreement will be responsible for paying the monthly Medicare Part D premium or may opt to switch plans any time throughout the year due to the lack of premium assistance.
If you are a CRDP cardholder enrolled in a Part D plan that is not a CRDP partner plan, CRDP will provide coverage during any deductible or coverage gap phases and payment for co-payment differences between the plan and CRDP. However, CRDP is not able to provide premium payments unless a premium payment agreement has been made between the non-partner plan and the Commonwealth.
If you would like to switch to a CRDP premium assistance plan in order to get the most help with your Part D costs, you can contact the program at 1-800-225-7223.
I had already joined a Part D plan on my own. Will the CRDP help me with the costs of that coverage?
The CRDP intends to help all cardholders with the costs of Part D coverage. If the Part D plan you are enrolled in has a signed agreement with the Commonwealth, the CRDP will be able to coordinate with that plan and help with the costs of your coverage.
When did CRDP start working with Part D?
CRDP began working with Part D effective October 1, 2006. Using your Part D identification card along with your CRDP card at the pharmacy will help provide cardholders with the lowest out-of-pocket expense at the pharmacy.
How will pharmacies know about these changes?
CRDP staff has informed pharmacies about how the CRDP works with Part D. We continue to share information with the pharmacy network on a regular basis.
I am not currently enrolled in CRDP. If I enroll in the program, will I be automatically enrolled in Part D?
If you are enrolled in a Part D plan when you enroll in CRDP, you can stay enrolled in the Part D plan. If it is not a CRDP premium assistance plan, we may not be able to help with all the Part D costs.
If you are eligible for Medicare and not enrolled in Part D when you enroll in CRDP, we will not assign you to a Part D plan immediately upon enrolling in CRDP. CRDP is a State Pharmaceutical Assistance Program (SPAP). As an SPAP, CRDP cardholders have two enrollment periods for Medicare Part D - an annual enrollment period and a special enrollment period. Contact CRDP for more information at 1-800-225-7223.
Who will pay the Part D premium?
The CRDP Program will pay the Part D premiums for CRDP cardholders up to the regional benchmark, which is $37.45 in 2021. However, in order for this to occur, the CRDP must execute agreements with the Part D plans. If you are enrolled in a plan that is not a premium assistance plan, then CRDP will not be able to pay towards your monthly Medicare Part D premium cost.
If I am enrolled in Part D, will I still use my CRDP Card?
Yes, show both cards at the pharmacy. This will tell your pharmacist to bill your Part D plan first, and bill CRDP second. It will also tell your pharmacist that you are entitled to all of the drugs that are available under CRDP.
Will my co-payments be higher with CRDP and Medicare Part D?
No. Enrolling in Part D and CRDP will help you receive lower out-of-pocket expense for drugs not covered by CRDP. In order to maximize your lowest out-of-pocket expense, present your Part D and CRDP cards to your pharmacist and make sure that the pharmacy can bill both programs for your prescription medications. If you are taking medications that are not covered by the CRDP, you will pay your Part D plan's co-pay for those drugs. If there is any confusion at your pharmacy, call the program's toll free number at 1-800-225-7223 while you are at the pharmacy.
Suppose my Part D plan charges lower co-payments than CRDP. What happens?
You will pay the lower co-payments.
Many Part D plans stop their coverage after you reach a certain dollar limit. This is sometimes called the doughnut hole. How does this work under Medicare Part D and CRDP?
The CRDP will fill in the gaps, so that you can continue to get your drugs just as you did under CRDP. However, if you are taking medications that are not covered by CRDP, then you will be responsible for the full cost of the medication that is charged to you by your Part D plan during the doughnut hole period, unless you have other prescription benefits that can be used during this time.
Suppose my Part D plan does not cover all of the drugs that CRDP covers?
The CRDP program will automatically pay for drugs that your Part D plan won't cover, so long as these are drugs covered by CRDP.
Can I go to any pharmacy I choose if I am in CRDP and Medicare Part D?
No, you must use the pharmacies that are in your Part D plan's network and participating with CRDP. If you decide to change pharmacies, check with your new pharmacy to make sure they participate in your Part D plan and CRDP.
If my Part D plan offers a mail-order service, can I use it?
Yes, but the mail-order pharmacy must participate with CRDP in order for the program to help pay for your extra copayments. Also, since you will be ordering a three-month supply of your drug by mail, you will be paying up to three CRDP copayments at once. For example, a CRDP cardholder would pay $18 for a 90-day supply of generic medications.
Where can I get a list of the mail-order pharmacies that I can use?
CRDP cardholders enrolled in Part D use the pharmacies that participate in the Part D plan's pharmacy network. If your Part D plan offers mail-order services, the plan has information for you regarding these pharmacies in their Welcome Kit and enrollment documents.
How did the program decide which Part D plan to enroll me in?
We looked at the drugs that you take that are covered by the CRDP and tried to match you up with a partner Part D plan that covers those medications. We also checked to make sure that your pharmacy participates in that plan.
Which Part D plans have partnered with CRDP? What are the premiums for each plan?
|2021 Partner Plans||Contact Number||2021 Monthly Premiums|
|Silverscript Choice Plan||1-855-271-2731||$32.90|
|WellCare Classic Plan||1-888-550-5252||$33.80 |
Are these the only plans that I can enroll in?
No, the CRDP has signed agreements with many Part D plans for 2021 that make it easier for the CRDP to coordinate with them and avoid confusion. Enrolling in one of these plans guarantees that you get the most help with your Part D plan costs.
Where can I get more information about the Part D plans available in PA?
Information about premiums, participating pharmacies and covered drugs for Part D plans operating in Pennsylvania is available by calling 1-800-Medicare (1-800-633-4227 or 1-877-486-2048 (TTY)) or on the web at: www.medicare.gov.
Can I pick a different plan from the one that the program has chosen for me?
Yes. During the Annual Open Enrollment Period from October 15 through December 7, Medicare beneficiaries can enroll, change, or terminate their Part D plan. The CRDP sends its members a notification regarding their personal plan selection before the start of this period. If you would like to pick a different partner plan, you should call 1-800-225-7223. If you want to enroll in a Part D plan that is not one of our partner plans, you should call Medicare at 1-800-633-4227.
If I am already enrolled in a Part D plan and have been paying my monthly premiums to the plan, will I still be switched over to the Part D plan that the CRDP program picked for me?
During the Open Enrollment Period, you will receive a letter from CRDP if you are already enrolled in Part D. The letter helps provide the lowest cost partner plan option for you in the upcoming year. You may remain in your current plan and are not required to change plans in order to remain in CRDP. You may continue to receive premium assistance from CRDP if your plan is on the premium assistance list.
What should I do if I receive a bill from my Part D plan for the monthly premium?
If you are enrolled in one of CRDP's partner plans, no premium assistance should be billed to you on a monthly basis. Instead, this monthly premium will be billed to CRDP and paid on your behalf. If you are enrolled in one of CRDP’s non-partner plans, you may receive up to the regional benchmark ($37.45 in 2021) towards your monthly Medicare premium and/or late enrollment penalty. If your monthly Part D premium and/or late enrollment penalty is over the regional benchmark, you will be responsible for the difference not reimbursed by CRDP.
The plan can bill a monthly late enrollment penalty if enrollment was not performed timely into Medicare Part D.
If you receive a bill from your Part D plan that you believe may not be your responsibility, please contact the program at 1-800-225-7223.
If I am in a Medicare Advantage plan without prescription drug coverage, do I have to change plans to enroll in Part D?
If you are in a Medicare Advantage Plan without prescription drug coverage and you would like to enroll in Part D, you need to contact your Medicare Advantage Plan to see if they offer a Part D benefit. If they do, you should enroll through your Medicare Advantage plan in order to minimize any disruption to your medical care. If you are in CRDP, the program will pay the Part D premium portion for you as long as the plan has signed a premium payment agreement with the CRDP.
If your Medicare Advantage Plan does not offer a Part D benefit, then you may need to join a different Medicare Advantage Plan through a different company to get Part D. Keep in mind that changing Medicare Advantage plans may affect your choice of doctors.