Why should I enroll in Part D if I have CRDP?
Under Federal regulations, Medicare beneficiaries have only 63 days to enroll in creditable coverage or Medicare Part D from the day they are initially eligible for Part D. Those who are eligible and do not enroll timely are assessed a lifetime monthly late enrollment penalty by Medicare.
Creditable coverage is one that is as good or better than Medicare Part D. Since CRDP drug coverage is not a creditable coverage, CRDP cardholders who become eligible for Medicare must choose either Medicare Part D or other creditable coverage. CRDP cardholders who do not enroll in Medicare Part D on time may face a lifetime late enrollment penalty.
Enrolling in Medicare Part D can also help reduce out-of-pocket costs for medications not covered by CRDP. When Medicare eligible individuals enroll in Part D, it reduces the costs for CRDP. Lessening the CRDP’s share of drug costs helps to expand benefits in the future.
Can I decide not to enroll in Part D?
Yes, you can choose not to enroll in Medicare Part D if you are enrolled in the CRDP. CRDP will continue to pay for your medications. However, if you lose CRDP coverage and need to enroll in Medicare Part D, or if you decide to enroll in Part D later, you may have to pay a higher monthly premium because CRDP is not considered a "creditable coverage."
Did all CRDP cardholders get enrolled in Part D?
No. CRDP enrolled cardholders into Part D if they were eligible for Part D coverage and had not yet enrolled on their own. Cardholders with creditable coverage through an employer or retiree plan, or those enrolled in a Medicare Advantage plan (Medicare HMO) should not have been enrolled into a stand-alone Part D plan by CRDP. If your enrollment into a Part D plan by CRDP negatively affected any other healthcare coverage you have, please contact the program at 1-800-225-7223.
How do I know if CRDP is enrolling me in Part D?
If CRDP enrolls you in a Part D plan, you will get a letter from the program telling you the name of the Medicare Part D plan we have selected for you. CRDP would not automatically enroll you in a Part D plan without telling you.
If you are enrolled in a Medicare Advantage plan (HMO) or have creditable coverage through your employer-sponsored retiree plan, CRDP will not enroll you in a stand-alone Part D plan. In this case, your current coverage is considered as good as or better than Medicare and you can stay in that plan instead of enrolling in Medicare Part D. If CRDP enrolled you in Part D, it could disrupt your health insurance or cause you to lose coverage completely. If you have these types of coverage, contact your insurance company for instructions on whether you should enroll in Part D.
I have not received any letter or information from CRDP about how they will work with my Part D plan. Does that mean I will not get help from CRDP with Part D costs?
All Medicare Part D plans must work with CRDP for prescription drug claims. This means prescription drugs covered by Medicare Part D that are also on the CRDP formulary (list of covered drugs) will give you the lowest out-of-pocket cost at the pharmacy.
Not all Medicare Part D plans work with CRDP for premiums. To maximize the help received with premiums, CRDP submits agreements to Part D plans in Pennsylvania each year. Plans that meet the Commonwealth’s requirements become premium assistance plans. CRDP cardholders enrolled in a Part D plan without a premium assistance agreement must pay the monthly Part D premium or can switch plans any time during the year due to the lack of premium assistance.
If you are a CRDP cardholder enrolled in a Part D plan that is not a CRDP partner plan, CRDP will cover any deductible or coverage gap periods and pay for copayment differences between the plan and CRDP. However, CRDP cannot make premium payments unless there is a signed premium payment agreement in place with the non-partner plan and the Commonwealth.
To get the most help with your Part D costs, you can switch to a CRDP premium assistance plan by contacting the program at 1-800-225-7223.
I joined a Part D plan on my own. Will the CRDP help me with the costs?
Yes, the CRDP intends to help all cardholders with Part D costs. If your Part D plan has an agreement with the Commonwealth, the CRDP can work with them to help with the costs.
When did CRDP start working with Part D?
CRDP began working with Part D on October 1, 2006. Using your Part D identification card and CRDP card at the pharmacy will give you the lowest out-of-pocket expense.
How will pharmacies know about these changes?
CRDP staff has notified pharmacies about how the CRDP works with Part D. We continue to share information with the pharmacy network on a regular basis.
I am not currently enrolled in CRDP. If I enroll in the program, will I be automatically enrolled in Part D?
If you are already enrolled in a Part D plan when you enroll in CRDP, you can stay enrolled in the Part D plan. However, if it is not a CRDP premium assistance plan, CRDP may not be able to help with all Part D costs.
If you are eligible for Medicare Part D but you are not enrolled in a Part D plan when you enroll in CRDP, we will not enroll you in a Part D plan immediately upon joining the program. CRDP is a State Pharmaceutical Assistance Program (SPAP). As a SPAP, CRDP cardholders have two enrollment periods for Medicare Part D - an annual enrollment period and a special enrollment period. Contact CRDP for more information at 1-800-225-7223.
Who will pay the Part D premiums?
The CRDP Program will pay the Part D premiums for CRDP cardholders up to the regional benchmark of $48.36 in 2025. However, for this to happen, the CRDP must already have agreements in place with the Part D plans. If you are enrolled in a plan that is not a premium assistance plan, CRDP will not be able to help pay your monthly Medicare Part D premium cost.
If I am enrolled in Part D, will I still use my CRDP card?
Yes, show both cards at the pharmacy. This will tell your pharmacist to bill your Part D plan first and CRDP second. It also shows that you are entitled to all the drugs covered by CRDP.
Will my copayments be higher with CRDP and Medicare Part D?
No. Enrolling in both Part D and CRDP will help you get lower out-of-pocket costs for drugs not covered by CRDP. To get the lowest out-of-pocket cost, show your Part D and CRDP cards to your pharmacist and make sure that the pharmacy can bill both programs. If you are taking medications that are not covered by CRDP, you will pay your Part D plan's copay for those drugs. If there is any confusion at your pharmacy, call the program's toll-free number at 1-800-225-7223 while you are there.
What if my Part D plan charges lower copayments than CRDP. What happens?
You will pay the lower copayments.
Many Part D plans stop their coverage after you reach a certain dollar limit. This is sometimes called the doughnut hole. How does this work under Medicare Part D and CRDP?
CRDP will cover the gaps so that you can continue to get your drugs just as you did under CRDP. However, if you take medications that are not covered by CRDP, you will be responsible for the full cost of those drugs during the doughnut hole period, unless you have other prescription benefits that can be used during that time.
What if my Part D plan does not cover all of the drugs that CRDP covers?
CRDP will automatically pay for drugs that your Part D plan does not cover, as long as they are covered by CRDP.
Can I go to any pharmacy I choose if I am in CRDP and Medicare Part D?
No, you must go to pharmacies that are in your Part D plan's network and participate with CRDP. If you change pharmacies, check with your new pharmacy to make sure they participate with your Part D plan and CRDP.
If my Part D plan offers a mail-order service, can I use it?
Yes, but the mail-order pharmacy must participate with CRDP for the program to help pay your extra copayments. Also, since most mail-order prescriptions come in 3-month supplies, you may be paying up to three CRDP copayments at once. For example, a CRDP cardholder would pay $18 for a 90-day supply of generic medications.
Where can I get a list of the mail-order pharmacies that I can use?
CRDP cardholders enrolled in Part D use the pharmacies that participate in the Part D plan's pharmacy network. If your Part D plan offers mail-order services, the plan provides information about these pharmacies in their Welcome Kit and enrollment documents.
How did the program decide which Part D plan to enroll me in?
We looked at the medications you take that are covered by CRDP and matched you up with a partner Part D plan that covers those medications. We also made sure that your pharmacy is part of that plan.
Which Part D plans have partnered with CRDP? What is the monthly premium for each plan?
| 2025 Partner Plans | Contact Number | 2025 Monthly Premiums |
|---|---|---|
| SilverScript Choice Plan | 1-855-271-2731 | $44.90 |
| WellCare Classic Plan | 1-888-550-5252 | $20.30 |
Are these the only plans that I can enroll in?
No, CRDP has signed agreements with many Part D plans for 2025 to make it easier to work with them and avoid confusion. Enrolling in one of these plans guarantees the most help with your Part D plan costs.
Where can I get more information about the Part D plans available in Pennsylvania?
You can get information about premiums, participating pharmacies and covered drugs for Part D plans in Pennsylvania by calling 1-800-Medicare (1-800-633-4227 or 1-877-486-2048 (TTY)) or on the web at: https://www.medicare.gov.
Can I pick a different plan from the one that the program has chosen for me?
Yes. During the Open Enrollment Period each year from October 15 through December 7, Medicare beneficiaries can enroll, change, or terminate their Part D plan. CRDP sends members a letter about their personal plan selection before this period starts. If you want to pick a different partner plan, call 1-800-225-7223. If you want to enroll in a Part D plan that is not one of our partner plans, call Medicare at 1-800-633-4227.
If I am already enrolled in a Part D plan and have been paying my monthly premiums, will I be switched to the Part D plan the CRDP picked for me?
During the Open Enrollment Period, CRDP will send you a letter if you are already enrolled in Part D. The letter will suggest the lowest cost partner plan for the next year. You can stay in your current plan and don’t have to switch to stay in CRDP. You can continue to get premium assistance from CRDP if your plan is on the premium assistance list.
What should I do if I receive a bill from my Part D plan for the monthly premium?
If you are enrolled in one of CRDP's partner plans, you should not be billed for the premium. The premium will be billed to CRDP and paid on your behalf. If you are enrolled in one of CRDP’s non-partner plans, you may receive help up to the regional benchmark ($48.36 in 2025) on your monthly Medicare premium and/or late enrollment penalty. If your monthly premium or penalty is more than the benchmark, you will have to pay the difference not covered by CRDP.
The plan can bill a monthly late enrollment penalty if you did not enroll in Medicare Part D on time. If you get a bill from your Part D plan that you think is not your responsibility, please contact the program at 1-800-225-7223.
If I am in a Medicare Advantage plan without prescription drug coverage, do I have to change plans to enroll in Part D?
If you are in a Medicare Advantage Plan without prescription drug coverage and want to enroll in Part D, contact your Medicare Advantage Plan to see if they offer a Part D benefit. If they do, you should enroll through your Medicare Advantage plan to avoid issues with your medical care. If you are in CRDP, the program will pay the Part D premium portion for you if the plan has an agreement with CRDP. If your Medicare Advantage Plan does not offer a Part D benefit, you may need to join a different Medicare Advantage Plan to get Part D. Remember, changing plans may affect your choice of doctors.