Humana Walmart-Preferred Rx Plan, MS 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||Yes|
|Drugs in Formulary:||3100|
|Drug Plan ID:||S5884-142|
|CMS Approved for:||MS Residents|
|Members in Region:||17389|
PDP Plan Highlights
MS Humana Walmart-Preferred Rx (PDP) is an approved Mississippi Medicare Part D Plan. The Humana Insurance Company plan is based on formulary 00012265 with 3100 drugs approved by the FDA. The annual premium is $222.00 ($18.50 monthly), and it carries a $325.00 deductible on all prescribed medications. The maximum deductible for 2013 is $325. This is regulated by CMS.
Mississippi seniors, several factors may increase or decrease this premium. For example, if you qualify for full or partial Extra Help, your premium could be lower. If you have a premium penalty (for late entry), your premium will be higher.
Humana Walmart-Preferred Rx 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.
If you choose Humana Walmart-Preferred Rx (PDP) your pharmacy co-pay in Mississippi will be tiered as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$1.00||258 Preferred Generics|
|2||$5.00||1044 Non-Preferred Generics|
|3||20%||885 Preferred Brand Drugs|
|4||35%||913 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The Initial Coverage Limit (ICL) is $2,970.00. This policy does qualify for the full LIS benefit ($0.00 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.
The Gap Coverage with this policy: You must pay the $3727.50.
Nation wide, the number of seniors using the Humana Walmart-Preferred Rx Plan policy is 1,412,142. In region 20 (your region) there are approximately 17,389 people with this policy (based on 2011 CMS statistics).
Facts About Humana Insurance Company
Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Essential Information About Medicare Part D
Pharmacist arrangements will vary with every prescription drug program. Many plans contain stringent geographic restrictions, including state borders, while others give nationwide pharmacy coverage. If you have an active lifestyle which consists of regular traveling, it will help you to have a policy that enables you to utilize pharmacies in all states.
Medicare Part D plans have a designated service area. It's the area where the provider does business. To sign up, you will need to live in the plan’s service area. Be aware that many carriers offer mail-order support. In this way you could have your pharmaceuticals mailed straight to your house. Your agent can help you select a program that meets what you need, so don’t hesitate to simply call and ask.
Each health insurance company establishes their own prices. Prices for approved drug plans can vary quite a bit, even to get equivalent coverage, therefore it will pay you to look prior to choosing.
Insurance companies publicize new prices along with other premium details each October. Do not forget to take a look at and evaluate premiums annually prior to open enrollment.
Be aware that if you don't register for a Medicare Part D insurance plan as soon as you are eligible, your long term premiums could be higher. This late entry consequence is established by Medicare, not the insurance providers. Each month you wait following eligibility you'll pay an extra 1% per month permanently.