Aetna CVS/pharmacy Prescription Drug Plan, TX 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||Yes|
|Drugs in Formulary:||3158|
|Drug Plan ID:||S5810-056|
|CMS Approved for:||TX Residents|
|Members in Region:||64353|
PDP Plan Highlights
TX 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 Amount||Medications in Tier|
|1||$3.00||1392 Preferred Generics|
|2||$10.00||529 Non-Preferred Generics|
|3||$33.00||329 Preferred Brand Drugs|
|4||39%||608 Non-Preferred Brand Drugs|
|5||25%||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.
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
Health care networks:
Products and programs:
Essential Information About Medicare Part D
Drugstore agreements will vary with every prescription drug plan. Some plans contain stringent regional limits, such as state borders, while some give nationwide coverage. For those who have an active personal life which consists of frequent traveling, it will assist you to have a policy that allows you to utilize pharmacies in all states.
Medicare Part D plans use a designated service area. It's the area in which the provider operates. To enroll, you need to reside in the plan’s provider area. Know that many carriers offer mail-order solutions. Therefore it's possible to have your prescription drugs shipped directly to your home. Your agent can help you select a plan that suits your requirements, so don’t be reluctant to phone and inquire.
Each health insurance supplier establishes their own rates. Prices for doctor prescribed drug plans vary quite a bit, even for identical coverage, so it will pay you to shop before you purchase.
Insurance providers announce new fees and other premium details each October. Be sure to check and evaluate premiums each year in advance of open enrollment.
Bear in mind that unless you register for a Medicare Part D insurance policy when you are eligible, your future monthly premiums will be higher. This late entry penalty is set by Medicare, not the insurance providers. Every month you delay following eligibility you will pay an additional 1% each month permanently.