Choose from 2 TEAMStar Medicare Part D Plans:
| Monthly Premium |  $30** |
 $85** |
||
| DRUG TYPE | RETAIL
30-Day Supply Copayment |
MAIL
90-Day Supply Copayment |
RETAIL
30-Day Supply Copayment |
MAIL
90-Day Supply Copayment |
| Preferred Generics Tier 1 |
$6 |
$12 |
$6 |
$12 |
| Preferred Brands Tier 2 |
$26 |
$52
|
$20
|
$40
|
| Non-Preferred Generics & Brands Tier 3 |
$52 |
$104
|
$30 |
$60 |
 | |
|||
** Monthly premiums will be reduced to $29 for the Silver plan and $84 for the Platinum plan if you elect to pay premiums by monthly bank draft.
Note: Monthly premiums shown do not reflect any Medicare imposed penalties for late enrollment.
With either the TEAMStar Silver or Platinum Part D plan, you pay a fixed copayment starting at just $6 for generic retail drugs. You will pay these copayments and the plan will pay the balance until the calendar year total of your copayments and the plan payments equals $2,700. Then your payments will depend on which plan you select. With the Silver plan you will pay 100% of your drug costs until your total calendar year out-of-pocket costs equal $4,350 in true out-of-pocket (TrOOP). With the Platinum plan, you pay a $6 copayment for preferred generics and 100% of your drug costs for all brands and nonpreferred generics until your total calendar year out-of-pocket costs (including copayments) equal $4,350. After your true out-of-pocket costs reach $4,350, you pay just 5%*, and the plan pays the rest on the Silver and Platinum plans.
Costs for prescription drugs that are not in the plan formulary do not qualify as out-of-pocket expenses for purpose of this calculation.
*After your yearly out-of-pocket drug costs reach $4,350, you pay the greater of: $2.40 for generic (including brand drugs treated as generic) and $6 for all other drugs, or 5% coinsurance. However, you will pay no more than $100 per prescription after TrOOP reaches $4,350. We pay the rest.
