Medicare Resources

CDPHP Medicare Choices Group Plans®

The working-aged and retirees are eligible to join CDPHP Medicare Choices group plans if they decide not to join their employer’s commercial plan offerings.
The rating methodology for the group Medicare products is a risk-adjusted community rate for all group sizes.
The national network cannot be added to group Medicare products.
The only type of contract offered under the group Medicare products is individual. There are no two-person or family contracts. All Medicare beneficiaries sign up as individuals.
New York state mandates, such as Timothy’s Law and the diabetic mandate, do not apply to group Medicare products. The group Medicare product requirements are determined by CMS.
However, Federal Mental Health Parity does apply to all group Medicare plans.

You can never say the word “free” in regards to Medicare Advantage plans.
You cannot refer to contracted providers as par or participating providers. You must refer to them as plan providers.
You cannot create your own marketing documents for CDPHP Medicare Choices plans.
You can never make direct comparisons to named competitors.
In regards to Medicare Advantage plans, the best description for a raffle prize contest is: “No-cost drawing without obligation.”

Under Part D, if the prescription plan has a coverage gap, only the member’s out-of-pocket expenses go toward meeting the limit set by the plan while in the coverage gap.
The CDPHP Medicare pharmacy brand manager is CVS/Caremark ®, which offers retail pharmacy, ExtraCare card discounts, and mail-order assistance and discounts through the FastStart program.
There is a late-enrollment penalty (LEP) for not joining a Part D plan when first eligible for Medicare Part A and/or B and going without creditable prescription drug coverage for 63 consecutive days or more. The LEP will be waived for any beneficiary eligible for the low-income subsidy.

The following criteria must be met in order for an eligible beneficiary to join a Medicare Advantage Plan:

After joining a Medicare Advantage Plan the Medicare beneficiary must continue to pay part B premiums.

Medicare beneficiaries who join group Medicare products are entitled to the same appeals and grievance process as Medicare beneficiaries who join an individual Medicare plan.
Medicare beneficiaries who join group Medicare products are entitled to the same pharmacy exception process as Medicare beneficiaries who join an individual Medicare plan.

Zostavax (shingles vaccine) is only covered under a plan with Part D and is subject to the Tier 1 copay.
Under the colonoscopy benefit, preventive screenings are covered in full and diagnostic testing is subject to the outpatient surgical copay.

For more information on these and other group Medicare topics, please refer to the reference materials.

If you have any questions or need additional assistance, please contact CDPHP Broker Services or call 1-800-993-7299.