Aetna CVS/pharmacy Prescription Drug Plan, TX 2013 PDP

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Summary Rating:This Medicare drug plan has an average rating of 2.5
Premium:
$30.60
Deductible:$325.00
Initial Coverage Limit:$2,970.00
Mail Order:Yes
Gap Coverage:No Gap Coverage
$0 Premium LIS Benefit:Yes
Drugs in Formulary:3158
Drug Plan ID:S5810-056
Plan Year:2013
CMS Approved for:TX Residents
Plan Type:National
Members in Region:64353

PDP Plan Highlights

Active Texas Senior, Medicare Part D Plan: Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-056TX Aetna CVS/pharmacy Prescription Drug (PDP) is a Medicare prescription drug plan underwritten by Aetna Medicare for eligible residents of Texas. The plan is approved by CMS for drug formulary 00012369, which has 3158 FDA approved medications. The monthly premium is $30.60 ($367.20 for a full 12 months) and the pharmacy deductible is $325.00 per year. The highest deductible allowed by CMS for 2013 is $325.

Texas 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.

Aetna CVS/pharmacy Prescription Drug Plan 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 Texas with this plan is as follows:

Tier  Co-Pay AmountMedications in Tier
1$3.001392 Preferred Generics
2$10.00529 Non-Preferred Generics
3$33.00329 Preferred Brand Drugs
439%608 Non-Preferred Brand Drugs
525%300 Specialty Drugs

The 2012 Initial Coverage Limit with Aetna CVS/pharmacy Prescription Drug Plan is $2,970.00. This drug plan qualifies for the full LIS benefit and a zero dollar monthly 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.

Plan Members

The number of Medicare recipients using the Aetna CVS/pharmacy Prescription Drug Plan plan nationally is 334,045. In your area (CMS PDP region 22) there are a reported 64,353 seniors on this plan. That's based on the previous year's reporting information.

Facts About Aetna Medicare

Membership:

  • 18.459 million medical members
  • 13.670 million dental members
  • 8.820 million pharmacy members

Health care networks:
  • More than 1 million health care professionals
  • More than 575,000 primary care doctors and specialists
  • More than 5,400 hospitals
  • A network of specialist physicians, recognized with Aexcel® designation, based on clinical performance and cost efficiency1 
Products and programs: 
  • Aetna offers a broad range of insurance and employee benefits products.
  • The first national, full-service health insurer to offer a consumer-directed health plan, Aetna continues to lead the way with its Aetna HealthFund2 line of products, including HSA, HRA and RRA options.
  • Aetna offers a wide array of programs and services that help control rising employee benefits costs while striving to improve the quality of health care, such as case management; disease management and patient safety programs; integrated medical, dental, pharmaceutical, behavioral health and disability information.
  • Aetna provides members with access to convenient tools and easy-to-understand information that can help them make better-informed decisions about their health and financial wellbeing.
National presence: 
  • Aetna provides benefits through employers in all 50 states, with products and services targeted specifically to small, mid-sized and large multi-site national employers.
  • Aetna also serves individuals and Medicare and Medicaid beneficiaries in certain markets.

Essential Information About Medicare Part D

Drugstore arrangements are unique with every drug program. Certain plans have stringent geographic restrictions, such as state boundaries, while some provide you with national drugstore coverage. If you have an active life which includes frequent traveling, it may benefit you to possess a policy that allows you to use pharmacies in all states.

Medicare Part D plans use a designated service area. This is basically the area where the provider operates. To enroll, you have to reside in the plan’s service area. Bear in mind that nearly all carriers offer mail-order solutions. Therefore it's possible to have your prescription drugs sent directly to your residence. Your advisor can assist you to find a program that meets what you need, so don’t hesitate to call and inquire.

Each health insurance provider sets their own prices. Monthly premiums for doctor prescribed drug plans can vary quite a bit, even for equivalent coverage, as a result it pays to look before you choose.

Insurance companies publicize new prices and other premium information each October. Be sure to check and evaluate rates each year prior to open enrollment.

Be aware that if you do not sign up for a Medicare Part D insurance policy once you first are eligible, your future monthly premiums could be higher. This late entry penalty is established by Medicare, not the insurance plan providers. Every month you postpone after eligibility you will pay an additional 1% each month forever.