PERS ODS Advantage PPORX (PPO) enrollment information

The PERS ODS Advantage PPORX plan is designed for Medicare-eligible individuals who wish to have one plan that includes both their medical coverage and their Medicare Part D prescription drug coverage. Medicare prescription drug benefits are available only to members of this plan. Enrollment into a prescription drug plan is voluntary.

To be eligible for this plan, you must meet the following requirements:

• You must have both Medicare Part A and Part B.
• You must reside in the state of Oregon.
• You must continue to pay your Part B premium (if not paid under Medicaid or a third party).
• You cannot enroll if you have end-stage renal disease (ESRD). If you are currently enrolled in a Moda Health medical plan, you may be able to enroll even if you are having renal dialysis or have had a recent kidney transplant. Contact member services for more information.

Note: If you are already enrolled in another Medicare Advantage prescription drug plan, you must receive your Medicare prescription drug benefit through that plan.

You can enroll in PERS ODS Advantage PPORX when you become eligible for Medicare, when you have a Special Election Period or during each PERS Health Insurance Program annual plan change period (October 1 through November 15 each year). For more information about when you can enroll, an enrollment form or if you have questions about enrolling, please contact the PERS Health Insurance Program.

If you choose to leave the PERS Health Insurance Program and do not join a prescription drug plan, you may have to pay more for your prescription drug coverage. There is a 1 percent per month penalty for each month during which you could have enrolled, but did not. The 1 percent penalty is based on the National Base beneficiary premium for Part D and can change each year. The penalty is $.31 per uncovered month in 2012.

For example, if a Medicare-eligible person who could have enrolled Jan. 1, 2009, delayed enrollment in a Medicare prescription drug plan until Jan. 1, 2010 and didn’t have creditable coverage, that member would have a penalty of 12 percent of $31.08 which equals $3.73. This beneficiary would have to pay $3.73 in addition to their Part D premium each month. This 12 percent is based on the 12 months from January 2009 through December 2009. The penalty applies for as long as the member is enrolled in a prescription drug plan.

Your coverage will generally be effective the first of the month following our receipt of a complete enrollment form. If you submit an incomplete enrollment form, we will contact you for more information. This can delay your effective date.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to seventy-five percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify won't have a coverage gap or a late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.