HealthSpring Prescription Drug Plan -Reg 9, SC 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||Yes|
|Drugs in Formulary:||2989|
|Drug Plan ID:||S5932-009|
|CMS Approved for:||SC Residents|
|Members in Region:||13761|
PDP Plan Highlights
SC HealthSpring Prescription Drug -Reg 9 (PDP) is a Medicare prescription drug plan underwritten by HealthSpring Prescription Drug Plan for eligible residents of South Carolina. The plan is approved by CMS for drug formulary 00012352, which has 2989 FDA approved medications. The monthly premium is $39.20 ($470.40 for a full 12 months) and the pharmacy deductible is $325.00 per year. The highest deductible allowed by CMS for 2013 is $325.
South Carolina 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.
HealthSpring Prescription Drug Plan -Reg 9 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 South Carolina with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||25%||1984 Preferred Generics|
|2||25%||1005 Non-Preferred Generics|
|3||0 Preferred Brand Drugs|
|4||0 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The 2012 Initial Coverage Limit with HealthSpring Prescription Drug Plan -Reg 9 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 HealthSpring Prescription Drug Plan -Reg 9 plan nationally is 466,785. In your area (CMS PDP region 9) there are a reported 13,761 seniors on this plan. That's based on the previous year's reporting information.
Facts About HealthSpring Prescription Drug Plan
Based in Nashville, Tennessee, HealthSpring got its start in 2000 and is now one of the country’s largest and fastest-growing coordinated care plans whose primary focus is Medicare Advantage plans. HealthSpring currently owns and operates Medicare Advantage plans in Alabama, Delaware, Florida, Georgia, Illinois, Maryland, Mississippi, New Jersey, Pennsylvania, Tennessee, Texas, and Washington, D.C., as well as a national stand-alone prescription drug plan.
Essential Information About Medicare Part D
Drugstore agreements are different with every drug program. Many plans have stringent geographic limitations, including state borders, while others give nationwide drugstore coverage. Should you have an active lifestyle which often includes regular traveling, it may assist you to have a policy that permits you to utilize pharmacies in all states.
Medicare Part D plans have a designated service area. This is basically the area in which the provider operates. To sign up, you need to reside in the plan’s services area. Bear in mind that many providers offer mail-order solutions. This way it's possible to have your pharmaceuticals sent directly to your house. Your representative will assist you to look for a program that suits your requirements, so don’t hesitate to phone and inquire.
Each health care insurance supplier sets its own prices. Prices pertaining to prescription drug plans can vary widely, even to get equivalent coverage, therefore it pays to look before you choose.
Insurance companies publicize new fees as well as other premium information each October. You'll want to check and evaluate rates annually in advance of open enrollment.
Bear in mind that if you don't sign up for a Medicare Part D insurance policy when you first are eligible, your future premiums will likely be higher. This late entry penalty is set by Medicare, not the insurance providers. Every month you wait following eligibility you will pay an additional 1% each month forever.