The Compass Rose Health Plan is introducing a new pharmacy benefit called the Compass Rose Medicare Prescription Drug Plan (PDP) EGWP for eligible members entitled to Medicare Part A and/or enrolled in Medicare Part B.
This Medicare PDP EGWP — a Medicare Part D plan — will provide enhanced prescription drug coverage with lower co-pays under each drug tier and a separate pharmacy out-of-pocket maximum to help members save on out-of-pocket costs.
That said, we know there may be additional questions about the Compass Rose Medicare PDP EGWP. Take a look at the frequently asked questions to get to know more about this plan.
What does EGWP stand for?
EGWP stands for Employer Group Waiver Plan. EGWPs are exclusive to Medicare-eligible members of a health plan.
Who is eligible for the Medicare PDP EGWP?
Members entitled to Medicare Part A and/or enrolled in Medicare Part B and not currently enrolled in the Compass Rose Medicare Advantage Plan will be automatically enrolled in the Medicare PDP EGWP. There is no required action from you to be enrolled.
Compass Rose Medicare Advantage includes Medicare Part D prescription drug coverage, which is why these plan members will not be enrolled in the standalone Medicare PDP EGWP.
What are the highlights of the Medicare PDP EGWP?
Medicare PDPs have made prescription drugs more affordable for the millions of retirees that depend on them. This Medicare PDP EGWP will provide enhanced prescription drug coverage, including:
- Lower out-of-pocket costs under each drug tier
- A more expansive 90-day retail pharmacy network
- Separate out-of-pocket maximums for medical and pharmacy costs
- An annual maximum of $2,000 on what you pay for prescriptions
Get to Know the Medicare PDP EGWP Features and Benefits
How do I know if my prescription is covered under the Compass Rose Medicare PDP EGWP?
You can use the Optum Rx® drug pricing tool online to see what is covered and what your current prescriptions will cost. To use the tool, visit compassrosebenefits.com/OptumRx.
If I currently have a prior authorization for a medication, will it transfer to the Medicare PDP EGWP?
Yes, prior authorizations that are approved prior to 2025 with effective dates that extend beyond the 2024 Plan year will transfer to the Medicare PDP EGWP.
Will I need new prescriptions for the Medicare PDP EGWP if I currently fill my prescriptions using Optum Home Delivery or Optum Specialty Pharmacies?
No, if there are active refills on your prescriptions they will be transferred to your Medicare PDP EGWP profile.
Can I opt-out?
If you are auto-enrolled and want to opt out from the Medicare PDP EGWP, your traditional FEHB High Option prescription benefits will apply. To opt out call Optum Rx at (844) 368-0690 or mail or fax a signed disenrollment request to:
Optum Rx Enrollment Services
Attn: Enrollment Services
PO Box 269027 Fort Lauderdale, FL 33326
Fax: 1-800-784-1580
Will my enrollment in this plan affect my Compass Rose Health Plan coverage?
No, your enrollment in this plan is in addition to your existing High Option Compass Rose Health Plan and your Medicare Part A and/or Part B coverage.
Am I still in the FEHB Program with the Medicare PDP EGWP?
Yes, you remain a Compass Rose Health Plan member within the FEHB program.
What happens if I have Medicare, but my spouse or other dependent does not?
The Compass Rose Medicare PDP is a benefit for eligible members who have or are entitled to Medicare coverage. If your covered spouse or other covered family members are entitled to Medicare Part A and/or enrolled in Medicare Part B and meet the other automatic enrollment rules, they will receive a letter in the mail. If your family member is enrolled in Compass Rose Medicare Advantage or does not have Medicare, they will keep their current Compass Rose prescription drug coverage.
What is an Income-Related Monthly Adjustment Amount (IRMAA)?
Depending on your income, you may need to pay an Income Related Monthly Adjustment Amount (IRMAA) for the Compass Rose Medicare PDP EGWP. IRMAA is an amount Social Security determines you may need to pay in addition to your monthly Part B and D premium if your modified adjusted gross income on your IRS tax return from 2 years ago is above a certain limit. Although you will not have an additional premium, the Medicare PDP EGWP is considered a Part D plan. Therefore, if you currently have or would be subject to a part B IRMAA, then you may incur an additional part D IRMAA when enrolling in this plan. Learn more at medicare.gov.
Will I need a new member ID card?
Yes, everyone enrolled in the Medicare PDP EGWP will have one, combined member ID card (provided by UMR) for both medical and pharmacy benefits. You will receive a new member ID card once your enrollment begins.
Eligible members will receive detailed communication in the mail. If you have further questions, please call Optum Rx toll free at (844) 368-0690 8 a.m. to 11 p.m. ET, 7 days a week, except holidays.