Important Notice from Confederated Tribes of the Colville Indian Reservation (2022)

Important Notice from Confederated Tribes of the Colville Indian Reservation

Regarding

Your Prescription Drug Coverage and Medicare in 2022

Please read this notice carefully and keep it where you can find it. This notice has information

about your current prescription drug coverage with Confederated Tribes of the Colville Indian

Reservation and about your options under Medicare’s prescription drug coverage. This

information can help you decide whether or not you want to join a Medicare drug plan. If you

are considering joining, you should compare your current coverage, including which drugs are

covered at what cost, with the coverage and costs of the plans offering Medicare prescription

drug coverage in your area. Information about where you can get help to make decisions

about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and

Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare.

You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare

Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare

drug plans provide at least a standard level of coverage set by Medicare. Some plans may also

offer more coverage for a higher monthly premium.

2. Confederated Tribes of the Colville Indian Reservation has determined that the prescription

drug coverage offered by the Confederated Tribes of the Colville Indian Reservation Health

Plan is, on average for all plan participants, expected to pay out as much as standard

Medicare prescription drug coverage pays and is therefore considered Creditable Coverage.

Because your existing coverage is Creditable Coverage, you can keep this coverage and not

pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

___________________________________________________________________

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year

from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of

your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a

Medicare drug plan.

CMS Form 10182-CC Updated April 1, 2011 According to the Paperwork Reduction Act of 1995, no persons are required to

respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this

information collection is 0938-0990. The time required to complete this information collection is estimated to average 8 hours

per response initially, including the time to review instructions, search existing data resources, gather the data needed, and

complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or

suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail

Stop C4-26-05, Baltimore, Maryland 21244-1850.

1

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your Confederated Tribes of the Colville Indian

Reservation coverage will be affected. See below for more information about what happens to

your current coverage if you join a Medicare drug plan.

Since the existing prescription drug coverage under Confederated Tribes of the Colville Indian

Reservation Health Plan is creditable (e.g. as good as Medicare coverage), you can retain your

existing coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as

a supplement in lieu of your existing health plan benefits.

If you do decide to join a Medicare drug plan and drop your Confederated Tribes of the Colville

Indian Reservation health plan, be aware that you and your dependents may not be able to get

this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Confederated Tribes

of the Colville Indian Reservation and don’t join a Medicare drug plan within 63 continuous

days after your current coverage ends, you may pay a higher premium (a penalty) to join a

Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your

monthly premium may go up by at least 1% of the Medicare base beneficiary premium per

month for every month that you did not have that coverage. For example, if you go nineteen

months without creditable coverage, your premium may consistently be at least 19% higher

than the Medicare base beneficiary premium. You may have to pay this higher premium (a

penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to

wait until the following October to join.

For More Information about This Notice or Your Current Prescription Drug Coverage…

Contact the person listed below for further information or call the District Office at 509-6342844. NOTE: You’ll get this notice each year. You will also get it before the next period you can

join a Medicare drug plan, and if this coverage through Confederated Tribes of the Colville

Indian Reservation changes. You also may request a copy of this notice at any time.

For More Information about Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the

“Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from

Medicare. You may also be contacted directly by Medicare drug plans.

CMS Form 10182-CC Updated April 1, 2011 According to the Paperwork Reduction Act of 1995, no persons are required to

respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this

information collection is 0938-0990. The time required to complete this information collection is estimated to average 8 hours

per response initially, including the time to review instructions, search existing data resources, gather the data needed, and

complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or

suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail

Stop C4-26-05, Baltimore, Maryland 21244-1850.

2

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see the inside back cover of your

copy of the “Medicare & You” handbook for their telephone number) for personalized

help

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug

coverage is available. For information about this extra help, visit Social Security on the web at

www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare

drug plans, you may be required to provide a copy of this notice when you join to show

whether or not you have maintained creditable coverage and, therefore, whether or not you

are required to pay a higher premium (a penalty).

CMS Form 10182-CC Updated April 1, 2011 According to the Paperwork Reduction Act of 1995, no persons are required to

respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this

information collection is 0938-0990. The time required to complete this information collection is estimated to average 8 hours

per response initially, including the time to review instructions, search existing data resources, gather the data needed, and

complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or

suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail

Stop C4-26-05, Baltimore, Maryland 21244-1850.

3