2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 6: What you pay for your Part D prescription drugs 163 Are you currently getting help to pay for your drugs? If you are in a program that helps pay for your drugs, some information in this Evidence of Coverage about the costs for Part D prescription drugs may not apply to you. We sent you a separate insert, called the “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” (also known as the “Low Income Subsidy Rider” or the “LIS Rider”), which tells you about your drug coverage. If you don’t have this insert, please call Customer Service and ask for the “LIS Rider.” Section 1 Introduction Section 1.1 Use this chapter together with other materials that explain your drug coverage This chapter focuses on what you pay for Part D prescription drugs. Your Plan Sponsor has chosen to make supplemental drug coverage available to you. This coverage is in addition to your Part D prescription drug benefit. Section 5.2 of this chapter contains a table that shows your costs for a drug that is covered by both your Part D prescription drug benefit and your supplemental drug coverage. For more information about this supplemental drug coverage you can view the Certificate of Coverage at retiree.uhc.com/wapebb or call Customer Service to have a hard copy sent to you. Your plan sponsor offers additional prescription drug coverage. Please see your Additional Drug Coverage list for more information. To keep things simple, we use “drug” in this chapter to mean a Part D prescription drug. As explained in Chapter 5, not all drugs are Part D drugs – some drugs are covered under Medicare Part A or Part B and other drugs are excluded from Medicare coverage by law. To understand the payment information, you need to know what drugs are covered, where to fill your prescriptions, and what rules to follow when you get your covered drugs. Chapter 5, Sections 1 through 4 explain these rules. When you use the plan’s “Real-Time Benefit Tool” to look up drug coverage (see Chapter 5, Section 3.3), the cost shown is provided in “real time” meaning the cost you see in the tool reflects a moment in time to provide an estimate of the out-of-pocket costs you are expected to pay. You can also obtain information provided by the “Real-Time Benefit Tool” by calling Customer Service. Section 1.2 Types of out-of-pocket costs you may pay for covered drugs There are different types of out-of-pocket costs for Part D drugs. The amount that you pay for a drug is called “cost-sharing,” and there are three ways you may be asked to pay. · The “deductible” is the amount you pay for drugs before our plan begins to pay its share. · “Copayment” is a fixed amount you pay each time you fill a prescription. · “Coinsurance” is a percentage of the total cost you pay each time you fill a prescription. Section 1.3 How Medicare calculates your out-of-pocket costs