CVS Caremark Value, FL 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||No|
|Drugs in Formulary:||2837|
|Drug Plan ID:||S5601-022|
|CMS Approved for:||FL Residents|
|Members in Region:||169781|
PDP Plan Highlights
FL CVS Caremark Value (PDP) is a Medicare prescription drug plan underwritten by SilverScript Insurance Company for eligible residents of Florida. The plan is approved by CMS for drug formulary 00012289, which has 2837 FDA approved medications. The monthly premium is $27.60 ($331.20 for a full 12 months) and the pharmacy deductible is $325.00 per year. The highest deductible allowed by CMS for 2013 is $325.
Florida seniors, be aware that a few different circumstances may decrease or increase your actual premium. Specifically, if you qualify for Extra Help (full or partial), your premium will decrease. On the other hand, if you have a premium penalty, your premium will be slightly more.
CVS Caremark Value Initial Coverage Phase
The Initial Coverage Phase (ICP) is your plan’s cost-sharing phase. During the ICP both you and your insurance provider share the cost of your prescription medications. This plan has a deductible, so your ICP does not start until the deductible has been paid.
Each medication is put into a tier within the plan’s formulary. This is simply a way for the insurer to manage cost-sharing. It’s important to note that every plan can put medications on any tier they deem suitable. This is not standardized, because it is based on cost and the various risk models used by the insurers.
The tiered prescription cost sharing (e.g., pharmacy co-pay) in Florida with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$6.00||1794 Preferred Generics|
|2||$45.00||704 Non-Preferred Generics|
|3||$95.00||96 Preferred Brand Drugs|
|4||25%||243 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The 2012 Initial Coverage Limit with CVS Caremark Value is $2,970.00. This drug plan doesn't qualify for a no cost LIS premium.
Coverage Gap Phase
The Coverage Gap, also known as the Donut Hole is the phase of your Part D plan where you must pay all of your medication costs. Healthcare Reform offers some additional assistance. For 2012 your insurance carrier will pay 7% of your generic drug prescription costs for you while you are in the donut hole. Likewise, the brand-name drug pharmaceutical companies cover half (50%) of your brand-name drug prescription costs. These subsidies count toward your True Out of Pocket (TrOOP) costs.
Some Medicare Part D plans provide additional Coverage Gap assistance that covers you above and beyond the discounts mandated by the Healthcare Reform Act. It’s important to note that if you have prescriptions that are not covered under your plan’s Gap Coverage, you will still get the generic and brand name drug discounts listed above, even if the plan itself does not offer gap coverage.
Here's how the carrier defines the 'donut hole' gap coverage for this policy: You must pay the $3727.50.
The number of Medicare recipients using the CVS Caremark Value plan nationally is 1,333,781. In your area (CMS PDP region 11) there are a reported 169,781 seniors on this plan. That's based on the previous year's reporting information.
Facts About SilverScript Insurance Company
Headquartered in Nashville, TN, SilverScript Insurance Company is a Medicare Prescription Drug Plan that contracts with Medicare and provides prescription drug plans in all 50 states and including the District of Columbia. SilverScript is a subsidiary of CVS Caremark. They offer two prescription drug plans: CVS Caremark Value and CVS Caremark Plus.
Essential Information About Medicare Part D
Pharmacist agreements will vary with every prescription drug plan. Some programs include stringent regional limits, such as state boundaries, while some provide national pharmacy coverage. For those who have an active lifestyle that consists of frequent traveling, it may help you to have a policy that enables you to use pharmacies in all states.
Medicare Part D plans use a specified service area. This is the area in which the provider operates. To sign up, you need to live in the plan’s provider area. Be aware that nearly all carriers provide mail-order services. Therefore you could have your medications sent straight to your home. Your agent can assist you to look for a plan that meets what you need, so don’t hesitate to phone and ask.
Each healthcare insurance provider establishes its own rates. Prices pertaining to health professional prescribed drug plans vary widely, even for equivalent coverage, as a result it will pay you to shop before you choose.
Insurance carriers publicize new fees as well as other premium information each October. Be sure to take a look at and compare rates each year in advance of open enrollment.
Bear in mind that if you don't register for a Medicare Part D insurance policy when you are eligible, your long term payments could be higher. This late entry penalty is established by Medicare, not the insurance suppliers. Every month you postpone after eligibility you will pay an additional 1% per month permanently.