Articles of Interest

“Observation” status can be costly for Medicare subscribers. This article, published with the permission of AARP, explains what to watch out for when you visit the emergency room, think you are admitted to the hospital, or go to a rehabilitation facility.

MDA Retiree Medical Plan

MDA insurance exclusively offers two unique MDA Retiree Medical plans that pay eligible expenses that Medicare does not pay. These plans are administered through AmWINS Group Benefits and insured by United American Insurance Company and are accepted anywhere that Medicare is accepted. To be eligible to participate, an MDA member and/or spouse must either be age 65 or older or under age 65 and disabled, and be enrolled in Medicare Part A and Part B.

Plan 1

Plan 1 is closed as of January 1, 2018. Benefits are for those currently enrolled only.

* This plan is no longer available for new enrollees as of 12/31/16.

Plan 2

Plan 3

4-Tier Medicare Part D Plan – Basic

This plan offers a 4-tier co-payment plan for prescription drugs. This is a plan with a $275 Brands Only Deductible. You will be responsible for a co-payment for your prescription drugs.

 Annual Deductible $275.00 Brands Only
Basic 4-Tier Medicare Part D Plan
Level 30-Day Retail Co-Pay 90-Day Mail Order Co-Pay

Preferred Pharmacies/

Standard Pharmacies

Tier 1 – Generic Drugs $10 $20/$30
Tier 2 – Preferred Brand Drugs $50 $100/$150
Tier 3 – Non-Preferred Brand $105 $210/$315
Tier 4 – Specialty Drugs

Coverage Gap (Donut Hole): Generics Only

30%

 

30%/30%

 

After your total yearly drug costs reach $4,660, you will pay the same copay schedule as noted above for Generic Drugs only. Member copays on Brand Drugs will be 25%. If your out-of-pocket costs reach $7,400 (“Catastrophic Limit”) your co-payment will be reduced to the greater of a $4.15 co-payment for generic drugs (including brand drugs treated as generic) and a $10.35 co-payment for all other drugs, or a 5% co-insurance.

 

5-Tier Medicare Part D Plan – Enhanced

This plan offers a five tier co-payment plan for prescription drugs. This is a plan with no annual deductible. You will be responsible for a co-payment for your prescription drugs.

 Annual Deductible $0
Enhanced 5-Tier Medicare Part D Plan
Level 30-Day Retail Co-Pay 90-Day Mail Order Co-Pay
Tiers 1 & 2 – Preferred and Non-Preferred Generic Drugs
Pay this copay even in the Part D donut hole
$10 $20
Tier 3 – Preferred Brand Drugs
Pay this copay even in the Part D donut hole
$45 $90
Tier 4 – Non-Preferred Brand
Pay this copay even in the Part D donut hole
50%
($70 min.-$100 max)
50%
($140 min.-$200 max)
Tier 5 – Specialty Drugs
Pay this copay even in the Part D donut hole
30%

($500 max)

30%

($1000 max)

After your total yearly drug costs reach $4,660, you will pay the same copay schedule as noted above. If your out-of-pocket costs reach $7,400 (“Catastrophic Limit”) your co-payment will be reduced to the greater of a $4.15 co-payment for generic drugs (including brand drugs treated as generic) and a $10.35 co-payment for all other drugs, or a 5% co-insurance.

Customer Service Commitment

AmWINS and MDA Insurance are committed to providing the highest quality services to those participating in our group Retiree Health plan that supplements Medicare. To that end, you may call either MDA Insurance or AmWINS Group Benefits.

MDA Insurance is available from 8 a.m. until 5 p.m. Monday through Friday at 877.906.9924.

AmWINS Group Benefits is available from 8 a.m. to 8 p.m. Monday through Friday at 877.248.7595

Any time you have a question about your benefit or claim, call MDA Insurance or AmWINS Group Benefits for a courteous, knowledgeable and prompt response.