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
Drugstore agreements will vary with each prescription drug plan. Certain plans include stringent geographic restrictions, including state borders, while others provide you with national pharmacy coverage. Should you have an active lifestyle which consists of frequent traveling, it will help you to have a policy that allows you to use pharmacies in all states.
Medicare Part D plans have a specified service area. It's the area where the provider operates. To enroll, you must live in the plan’s provider area. Be aware that nearly all carriers offer mail-order solutions. This way you could have your pharmaceuticals sent directly to your house. Your advisor will assist you to find a plan that suits what you need, so don’t hesitate to call and ask.
Each and every health care insurance provider establishes their own prices. Monthly premiums pertaining to doctor prescribed drug plans vary widely, even for equivalent coverage, as a result it pays to shop prior to choosing.
Insurance companies announce new prices and other premium information each October. Do not forget to take a look at and evaluate rates every year just before open enrollment.
Be aware that if you don't sign up for a Medicare Part D policy when you first are eligible, your future premiums will probably be higher. This late entry consequence is set by Medicare, not the insurance suppliers. Every month you postpone after eligibility you'll pay an additional 1% per month permanently.