Medicare Part D FAQ

Medicare Part D became effective Jan. 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare Part D is a prescription drug benefit provided by private insurance companies and other providers approved by Medicare and contract with the federal government.

Who qualifies for TEAMStar Part D?
Teamster retirees, spouses, and surviving spouses who are entitled to Medicare Part A and/or enrolled in Medicare Part B and live in the plan service area qualify for TEAMStar Prescription Drug Plans (PDP). Participation is not automatic — you must enroll in Medicare Part D to receive benefits. You are entitled to this program regardless of your health history or the drugs you take.

When can I sign up?
Your participation in Part D is not automatic. The annual enrollment period (AEP) begins Oct. 15 and ends Dec. 7, with coverage taking effect Jan. 1 of the following year. Provided you maintain continuous coverage, individuals enrolled in Medicare Part D are allowed to switch plans every year, during the AEP, which will be effective Jan. 1 of the following year.

What are the benefits of Part D?
Whatever TEAMStar plan you choose, Medicare prescription drug coverage assists with your expenses for brand and generic drugs.

How much does it cost?
Although Medicare subsidizes the cost, you must pay a monthly TEAMStar Part D premium. Additionally, you may pay a deductible, depending on which plan you choose. You also are responsible for a copayment/coinsurance for your prescription drugs, which varies too, depending on which TEAMStar plan you choose.

Most people will pay their Part D premium. However, some people will pay a higher premium because of their yearly income (over $85,000 for singles, $170,000 for married couples). For more information about Part D premiums based on income, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

You may also call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778.

Can I qualify for Extra Help?
If you have limited income and financial resources, you may qualify for assistance in the form of reduced or eliminated premiums and/or cost sharing. You can apply online at www.socialsecurity.gov/prescriptionhelp or get more information about this assistance by calling Medicare at 1-800-633-4227 (TTY/TDD: 1-877-486-2048) or the Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778).

Am I protected against increased drug costs?
Enrollment in TEAMStar Part D could buy you the protection you need for your drug costs. Remember, using generics can help reduce your prescription costs. If you are enrolled in TEAMStar Part D, you can also participate in the Low-Cost Generics Program, which can further reduce your drug costs.

Will I pay more if I enroll late?
You may pay a late enrollment penalty if you don't join a Medicare prescription drug plan when you are first eligible to join during your Initial Enrollment Period (IEP), or there is a period of 63 or more continuous days during which you don't have creditable prescription drug coverage as good as Medicare's prescription drug coverage.

If a late enrollment penalty applies, it is calculated by Medicare when you first join a Medicare drug plan. To estimate your penalty, take one percent of the national average premium for the year you join (The 2012 national average premium is $31.08). Multiply it by the number of full months you were eligible to join a Medicare prescription drug plan but didn't. This is your estimated penalty amount, which is added each month to your Medicare prescription drug plan's premium, for as long as you have the plan. If you qualify for extra help, the penalty is different. For help figuring out how much your penalty will be, call 1-800-MEDICARE/1-800-633-4227 (TTY/TDD: 1-877-486-2048), or call your State Health Insurance Assistance Program.

Are the drugs I need covered by Medicare Part D?
Covered drugs can vary from plan to plan, so be sure to review each plan's formulary information. You may want to consider switching your prescription to an equivalent drug if a drug you are using is not available through a particular plan.

If you need to see if your drugs are covered by TEAMStar Part D, click here.

Do I get a discount on prescription drugs?
Because TEAMStar has developed a network of pharmacies, you have access to discounted prices if you join TEAMStar Medicare Part D and use the plan's pharmacy network. In addition, TEAMStar Part D has a Union Preferred network, which can save even more money. Medicare Part D plans use various networks, so be sure to check to see if your preferred pharmacy is in the network.

If you want to see if your pharmacy is in our network, click here.

How does healthcare reform affect TEAMSter Medicare Part D?
The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the coverage gap and are not already receiving "Extra Help." A 50% discount on the negotiated price (excluding the dispensing fee) will be available for those brand name drugs from manufacturers that have agreed to pay the discount. We will automatically apply the discount when your pharmacy bills you for your prescription and your Explanation of Benefits will show any discounts provided. The amount discounted by the manufacturer counts toward your out-of-pocket costs as if you had paid this amount and moves you through the coverage gap.

In addition, TEAMStar Part D will pay 14% of your generic drugs while you are in the Coverage Gap.

Click here to see what your cost sharing is under TEAMStar Part D.

How can I be sure your plan offers pharmacies that are convenient?
You can learn which pharmacies are 'in-network' for each plan — offering the best prices for medications and the lowest cost sharing rates. If the 'in-network' pharmacies available in a plan are not local, you may find that using a mail order pharmacy to obtain medications is the most cost-effective option. Of course, you may choose to eliminate local pharmacy fulfillment altogether and use the mail order pharmacy option from the beginning as the most convenient and cost-effective method.

Click here to see if your local pharmacy is in our network.

What should I 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. You 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 need to make this fall regarding if and when you sign up for Medicare prescription drug coverage.

If you or your spouse's employer or union determines 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 plan to give you more complete prescription drug coverage.
Drop your current coverage and return to the original Medicare plan.
Join a Medicare prescription drug plan.
Join a Medicare Advantage plan or other Medicare health plan that covers prescription drugs. See the caution above.

What should I know if I have drug coverage from TRICARE, the Department of Veteran's Affairs (VA), or the Federal Employee Health Benefits Program (FEHB)?
Contact your Benefits Administrator or FEHB insurer for information about your TRICARE, VA, or FEHB coverage before making any changes. It is almost always 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.

How do I end my membership in your plan?
Usually, to end your membership in a Plan, you simply enroll in another Medicare Part D plan during an enrollment period. If you do not want to keep a Plan, you can choose to enroll in another Medicare prescription drug plan or to drop your Medicare prescription drug coverage.

If you would like to switch from our plan to:

Another Medicare prescription drug plan
Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our Plan when your new plan's coverage begins.
A Medicare Advantage Plan
Enroll in the Medicare Advantage plan. With most Medicare Advantage plans, you will automatically be disenrolled from our Plan when your new plan's coverage begins. However, if you choose a Private Fee-For-Service plan without Part D drug coverage, a Medicare Medical Savings Account plan, or a Medicare Cost plan, you can enroll in that new plan and keep our Plan for your drug coverage. If you want to leave our Plan, you can either enroll in another Medicare prescription drug plan or contact our TEAMStar Medicare Part D Customer Service, or Medicare, and ask to be disenrolled. Call us toll-free: 1-866-524-4173. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4174. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048.
Original Medicare without a separate Medicare prescription drug plan
Contact our TEAMStar Medicare Part D Customer Service and ask to be disenrolled from the Plan. Call us toll-free: 1-866-524-4173. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4174. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048.

updated 10/01/11