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

Pharmacy contracts will vary with each drug program. Certain plans include strict regional restrictions, that include state borders, whilst some give national drugstore coverage. Should you have an active personal life that includes regular traveling, it's going to benefit you to have a policy that permits you to use drug stores in all states.

Medicare Part D plans use a specified service area. It's the area where the provider operates. To enroll, you have to live in the plan’s provider area. Remember that nearly all providers offer mail-order solutions. Therefore you could have your prescription drugs shipped directly to your residence. Your agent can help you find a program that meets your needs, so don’t be reluctant to call and ask.

Each and every health insurance supplier sets its own rates. Monthly premiums pertaining to prescription drug plans vary quite a bit, even to get identical coverage, so it pays to look before you purchase.

Insurance companies announce new fees along with other premium information each October. Do not forget to take a look at and compare premiums each year prior to open enrollment.

Bear in mind that if you don't register for a Medicare Part D policy as soon as you are eligible, your future premiums will likely be higher. This late entry penalty is set by Medicare, not the insurance companies. Every month you wait after eligibility you'll pay an additional 1% per month permanently.