Basic Information
What is Medicare Prescription Drug Coverage?
Medicare Part D became effective January 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It is a prescription drug benefit that is provided by private insurance companies who have been approved by Medicare and contract with the federal government. This drug coverage may help lower prescription drug costs and help protect against higher costs in the future.
Should I join a Medicare drug plan even if I don’t take many prescription drugs?
You should still consider joining a Medicare drug plan. As we age, most people need prescription drugs to maintain their health.
If you need additional help:
- Visit www.medicare.gov on the Internet and get personalized information.
- Call 800-MEDICARE/800-633-4227 (TTY/TDD users: 877-486-2048). Have your Medicare card, a list of drugs you use, and the name of your pharmacy when you call.
- Call your State Health Insurance Assistance Program for free personalized health insurance counseling.
- Contact your local office on aging. Or visit www.eldercare.gov on the Internet.
Important Dates
When can I join a Medicare drug plan?
You will be able to join Nov. 15 – Dec. 31 each year for coverage beginning Jan. 1 of the following year. If you choose not to join when you are first eligible and later change your mind, you may pay a penalty.
Costs and Coverage
Will my drugs be covered?
Make a list of all the your current medications, including name, dose size (for example: 2 pills, 300mg in each pill), dosage frequency (for example: 2 times a day), and monthly costs of your current prescriptions. You can compare your information to the list of drugs (also called a formulary) covered under the TEAMStar Medicare Part D plan. To see which drugs TEAMStar Medicare Part D covers, visit our online formulary.
Effect on Current Drug Coverage
What do I need to know if I have prescription drug coverage from a former or current employer or union?
Medicare will help employers or unions continue to provide retiree drug coverage that meets Medicare’s standards. Your (or your spouse’s) former or current employer or union will send you information about how your current coverage compares to the Medicare standard prescription drug coverage. This information is important because it can affect the decision you will need to make this fall regarding if and when you sign up for Medicare prescription drug coverage.
If your (or your spouse's) employer or union has determined that your current coverage, on average, is at least as good as the Medicare standard prescription drug coverage (called creditable prescription drug coverage):
- You can keep it as long as it is still offered by your employer or union.
- You won't have to pay a penalty if your employer or union stops offering prescription drug coverage as long as you join a Medicare drug plan within 63 days after the coverage ends.
Caution: If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage.
If your employer or union plan is not as good as Medicare prescription drug coverage, find out about your options from your benefits administrator. You may be able to:
- Keep your current employer or union drug plan and join a Medicare drug to give you more complete prescription drug coverage.
- Drop your current coverage and return to the Original Medicare Plan and join a Medicare prescription drug plan, or join a Medicare Advantage Plan or other Medicare health plan that covers prescription drugs. See the caution above.
What do I need to know if I have drug coverage from TRICARE, the Department of Veteran’s Affairs (VA), or the Federal Employee Health Benefits Program (FEHB)?
You should contact your benefits administrator or FEHB insurer for information about your TRICARE, VA, or FEHB coverage before making any changes. It will almost always be to your advantage to keep your current coverage without any changes. If you lose your TRICARE, VA, or FEHB coverage, in most cases, you won't have to pay a penalty, as long as you join a Medicare drug plan within 63 days of losing TRICARE, VA, or FEHB coverage.
What do I need to know if I have full coverage from my state Medicaid program?
Your Medicaid prescription drug coverage has changed. Medicare, not Medicaid, now pays for your prescription drugs. Medicaid will still cover other care that Medicare doesn’t cover.
You will have continuous Medicare prescription drug coverage and, in most cases, will pay a small amount out of your own pocket. Medicare pays for almost all of the cost of your drugs if you join a Medicare prescription drug plan or a Medicare Advantage Plan or other Medicare health plan with Medicare prescription drug coverage.
Compare coverage and choose a plan. If you did not join a drug plan by December 31, 2005, Medicare enrolled you in the plan it picked to make sure you didn’t miss a day of coverage. If you decide you want another plan, you can switch to another plan at any time without a penalty.
If you have Medicare and full coverage from Medicaid, and live in an institution (like a nursing home), you will pay nothing for your covered prescription drugs.
What do I need to know if I have the Original Medicare Plan (Medicare Part A and Part B) and I don’t have prescription drug coverage?
To have Medicare help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. You can choose and join the plan that meets your needs. If you don’t use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you won’t have to pay a penalty if you choose to join later. Your premium will be higher if you wait to join after you are first eligible.
You can first join a drug plan from Nov. 15 – Dec. 31 each year. In most cases, if you don’t join during this period, your next chance to join will be Nov. of the following year you will have to pay a penalty. This means you pay a higher monthly premium for as long as you have Medicare prescription drug coverage.
What do I need to know if I have a Medigap (Medicare Supplement) policy that doesn’t cover prescription drugs and I have the Original Medicare Plan (Medicare Part A and Part B)?
To have Medicare help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. You can choose and join the plan that meets your needs. If you don’t use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means you won’t have to pay as much of a penalty if you choose to join later. Your premium will be higher if you wait to join after Dec. 31.
Contact your Medigap insurer for information about your policy. If you have your Medigap policy from a current or former employer or union, call your benefits administrator.
What if I have limited income and resources?
People with limited income and resources may qualify for extra help paying for Medicare prescription drug costs. The amount of extra help you get is based on your income and resources.
Can I qualify for extra help?
If you have limited income and financial resources and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information by calling the Social Security Administration at 800-772-1213 (TTY: 800-325-0778).
