Basic Information
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. It is a prescription drug benefit that is provided by private insurance companies and other providers that have been approved by Medicare and contract with the federal government.
Who qualifies for Teamstar Medicare Part D?
A Teamster can join this Medicare Part D plan if entitled to Medicare Part A and/or enrolled in Medicare Part B and lives in the plan’s service area.
When can I sign up?
Your participation in Part D is not automatic. The annual enrollment period (AEP) begins Nov. 15 and ends Dec. 31, with coverage taking effect Jan. 1 of the following year. Provided that you maintain continuous coverage, individuals enrolled in Medicare Part D are allowed to switch plans every year between Nov. 15 and Dec. 31, to take effect Jan. 1 of the following year.
What are the benefits of Part D?
Whatever plan you choose, Medicare prescription drug coverage assists with your expenses for brand name and generic drugs.
How much does it cost?
Although Medicare pays a substantial portion of the cost, you must enroll in a Part D plan by paying a monthly 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 plan you choose.
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 deductibles. You can apply for 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 Part D could buy you the protection you need if your drug costs become very high. Remember, using generics can help keep down prescription costs.
Do I get a discount on prescription drugs?
You have access to discounted prices if you join a Medicare prescription drug plan and use the plan's pharmacy network. Part D plans use various networks, so be sure to check to see if your preferred pharmacy is in the network.
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 Intial 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.
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 2010 national average premium is $31.94). 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 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.
How can I be sure that 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.
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. 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 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 determines 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 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 our Plan, you simply enroll in another Medicare Part D plan during an enrollment period. If you do not want to keep our 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.
