We know you may have questions or need assistance during this transition. You can reach OptumRx Member Services at (855) 409-6999. Representatives are available 24 hours a day, 7 days a week.

OptumRx Transition Frequently Asked Questions

Enhanced Employer Group Waiver Plan (EGWP) Frequently Asked Questions

We are updating the FAQs regularly, please keep checking back for new information!

Here are some recent additions:

OptumRx told me that I won’t be enrolled in the enhanced EGWP until February 1, 2019. Will I still have pharmacy benefits during January 2019?

Some Medicare eligible AlaskaCare retirees may experience a delayed enrollment in the enhanced EGWP until OptumRx can confirm and reconcile that members’ personal information with Medicare. Affected individuals will not experience a disruption in coverage; they will continue to receive full pharmacy benefits through the standard AlaskaCare pharmacy benefit until their enrollment in the AlaskaCare enhanced EGWP can be properly processed. For more information about your specific situation, please contact OptumRx member services at (855) 409-6999.

I submit paper claims for my prescription benefits. Who should I send 2018 claims to if they haven’t been filed prior to January 1?

For all prescriptions filled prior to January 1, 2019, the claims should be submitted to Aetna/CVS. For any prescription filled on or after January 1, 2019, the claims should be submitted to OptumRx. Claims forms for both can be found online at AlaskaCare.gov.

Why did I receive a new ID card from Aetna? I thought my medical benefits weren’t changing?

The transition to OptumRx does not affect your medical benefits—these continue to be administered by Aetna. However, because Aetna and its contractor, CVS/Caremark, no longer administer AlaskaCare pharmacy claims, all AlaskaCare members will receive updated ID cards from Aetna that reflect their medical benefit coverage. Retirees will receive two new ID cards from Aetna – one for medical coverage, and one for vision/audio coverage. You should use your Aetna ID card(s) at your doctor’s office, and your OptumRx ID card at the pharmacy counter.

I received a letter from OptumRx asking me to provide a residential address. I use a P.O. Box to receive my mail, why am I being asked to provide a residential address?

You are welcome to use a P.O. Box as your mailing address, but in order for you to participate in a Medicare Part D pharmacy plan (i.e. the AlaskaCare enhanced EGWP), Federal regulations require OptumRx to confirm you reside within the Medicare service area: the United States, Puerto Rico, or Guam. Providing a residential address will verify your eligibility to be covered under the AlaskaCare enhanced EGWP.

The letter I received asking me to provide a residential address made it sound like I could lose my prescription drug coverage – is this true?

We apologize for the tone of the letter. The intent was to emphasize that in order for AlaskaCare to continue to receive federal subsidies associated with your enrollment in EGWP, you must provide a residential address. You will not lose your coverage – AlaskaCare will always continue to provide you with prescription drug coverage.

I received a phone call from an OptumRx representative, but my caller-ID says the call is coming from United Health Care. Is this a scam?

OptumRx is a subsidiary of United Health Care, which is why “United Health Care” may appear on your caller-ID when you receive a call from OptumRx. This is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

I received a call from an OptumRx representative who stated my mail-order prescriptions have transferred over and then asked me for personal information. Is this a scam?

If you were previously enrolled in the Aetna pharmacy mail-order program, most remaining prescription fills were transferred automatically to OptumRx’s home delivery program. The OptumRx home delivery unit has been reaching out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

Still Have Questions?

You can read more about the 2019 pharmacy benefits transition on the AlaskaCare website. If you or your family member enrolled in the retiree health plan are Medicare eligible, or will be Medicare eligible soon, you may have more specific questions about the enhanced EGWP—a Medicare Part D group pharmacy plan. For questions about EGWP, visit our EGWP FAQs page. Check these pages frequently, as we are updating the FAQs regularly as we receive and respond to member questions.

You can contact OptumRx Member Services at (855) 409-6999, or the Division toll-free at (800) 821-2251, or in Juneau at (907) 465-4460. You can also e-mail the Division at doa.drb.benefits@alaska.gov.

Certain high-income retirees who are Medicare eligible and enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) pharmacy plan will have to pay an extra premium surcharge associated with Medicare Part D plans, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is required by Medicare and is the same type of surcharge that high-income enrollees already pay for a Medicare Part B plan. If you are an individual earning more than $85,000 per year or a married couple who earns more than $170,000 per year, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare EGWP because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are required to pay the IRMAA premium surcharge, the Division will reimburse you for the amount you are charged each month associated with Medicare Part D, so the EGWP plan is no additional cost to you. If this applies to you and you are subject to the IRMAA premium surcharge, read on to find out more about IRMAA and how to set up monthly reimbursement from the Division.

How Will I Know How Much it Will Be and if I Have to Pay IRMAA?

Each year, Medicare eligible individuals are notified by the Social Security Administration about your plan, including if you are required to pay an IRMAA and at what amount. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) to determine if the IRMAA applies to you and, if so, how much you will have to pay.

The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return. The MAGI, and therefore the amount of your IRMAA, is subject to change from year to year.

I Believe I Am Required to Pay IRMAA. What Do I Do Next?

If you are subject to the IRMAA surcharge for the EGWP pharmacy plan, you will be reimbursed for this surcharge. For all Medicare plans, IRMAA is deducted directly from your monthly Social Security check if you qualify for Social Security or is invoiced to you directly each month if you don’t receive Social Security. Unfortunately, the Division cannot pay your monthly IRMAA on your behalf—but we can reimburse you each month through a tax-advantaged Health Reimbursement Arrangement (HRA) account for the portion of the surcharge associated with your prescription drug coverage, so there is no additional cost to you.

Each November, you should receive a letter from Social Security that outlines your Medicare premiums. Please submit the most recent letter you’ve received from Social Security that states you are subject to IRMAA surcharge for 2019, and at what amount, to the Division.

You can provide a copy of your letter to the division by:

• Emailing a copy or a photo of the letter to: drb.irmaa@alaska.gov.
• Mailing a copy to:
  Alaska Department of Administration
  Division of Retirement and Benefits
  P.O. Box 11023
  Juneau, AK 99811-0203
• Faxing a copy to: (907) 465-3086

Once the Division receives a copy of your annual letter sent from Social Security, we will establish an HRA for you through PayFlex, Aetna’s subsidiary that administers the HRA on behalf of AlaskaCare. PayFlex will send you a letter that outlines how to access your HRA account information and how to set up claims for reimbursement. We encourage you to set up reimbursement on an automatic reoccurring basis, but you may elect to request reimbursement manually. Reimbursement can be made by check or through electronic funds transfer.

For more information, download a copy of our IRMAA fact sheet.  

Alaskans are very familiar with seasonal affective disorder (SAD), but anyone who lives where there are seasonal changes in temperature, weather, and length of daylight can be affected by SAD. SAD symptoms typically appear or intensify during the fall and early winter and go away in the spring and summer when longer days return. SAD is said to occur due to changes in the body’s internal clock and changes in brain and body’s chemicals. Feeling depressed on most days, feelings of hopelessness, worthlessness, reduced energy, concentration, and lack of interest in the activities you enjoy are common symptoms. SAD can also be a sign of depression, especially if these feelings persist beyond the dark, winter months. Talk to your doctor: treatment for SAD is available in the form of medications, light therapy, and psychotherapy. And don’t forget about self-care!

Here are some tips to help cope with SAD during the winter months:

• Keep your house well lit.
• Sit closer to bright windows at home and when you are out and about, such as a coffee shop.
• Take a walk outside each day, especially during daylight hours.
• Exercise regularly, indoors and outdoors.
• Eat a well-balanced diet.
• Stick to your treatment plan.
• Practice relaxation techniques such as yoga, tai chi, and meditation.
• Practice music or art therapy.