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Washington, DC - District of Columbia 2006 Medicare Part D Plan Archive

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2006 Medicare Part D - Washington DC Plan Information
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Plan Name Monthly
Premium
Deductible Co-Pay
Tiered
Coverage
Coverage Gap
(Donut Hole)
Coverage
Mail Order
Available
Number of
Top 100
Drugs Covered
Aetna Life Insurance Company
» Summary of Benefits for all Aetna Plans » Drug Guide (Formulary)
Aetna Medicare Rx Essentials Plan $32.13 $250 Yes None Yes 82
Aetna Medicare Rx Plus Plan $42.82 None Yes Generics Only Yes 82
Aetna Medicare Rx Premier Plan $58.36 None Yes Generics Only Yes 95
Coventry AdvantraRx
» Summary of Benefits all plans » Drug Guide (Formulary) Value Plan
» Drug Guide (Formulary) Premier Plan
» Drug Guide (Formulary) Premier Plus
AdvantraRx Value $21.21 None Yes None Yes 73
AdvantraRx Premier $32.30 None Yes None Yes 97
AdvantraRx Premier Plus $44.16 None Yes None Yes 97
Humana, Inc.
  » Drug Guide (Formulary)
Humana PDP Standard S5884-063
» Summary of Benefits
$6.44 $250 No None Yes 100
Humana PDP Enhanced S5884-004
» Summary of Benefits
$12.58 None Yes None Yes 100
Humana PDP Complete S5884-033
» Summary of Benefits
$52.88 None Yes Generic &
Brand Drugs
Yes 100
PacifiCare Life and Health Insurance Company
PacifiCare Saver Plan $21.30 None Yes None Yes 77
PacifiCare Select Plan $34.10 None Yes None Yes 86
PacifiCare Complete Plan $38.16 None Yes Generics only Yes 77
Prescription Pathway
Pennsylvania Life Standard Defined
Reg 5
$31.59 $250 No None Yes 88
American Progressive Act Equ Std Reg 5 $40.85 $250 Yes None Yes 88
Pennsylvania Life Act Equ Std Reg 5 $40.89 $250 Yes None Yes 88
Marquette National Act Equ Std Reg 5 $40.97 $250 Yes None Yes 88
American Progressive Enhanced #1 Reg 5 $51.99 None Yes None Yes 88
Pennsylvania Life Enhanced #1 Reg 5 $52.00 None Yes None Yes 88
Marquette National Enhanced #1 Reg 5 $52.07 None Yes None Yes 88
Marquette National Enhanced #2 Reg 5 $68.64 None Yes None Yes 96
American Progressive Enhanced #2 Reg 5 $68.91 None Yes None Yes 96
United HealthCare Insurance Company
» Summary of Benefits » Drug Guide (Formulary)
United Medicare MedAdvance $30.85 None Yes None Yes 96
WellCare Health Plans
» Summary of Benefits for all WellCare Plans
» WellCare Plan Brochure
» WellCare Pharmacy Directory
WellCare Signature
» Drug Guide (Formulary)
» Evidence of Coverage
$19.80 None Yes None Yes 82
WellCare Complete
» Drug Guide (Formulary)
» Evidence of Coverage
$39.83 None Yes None Yes 83
WellCare Premier
» Drug Guide (Formulary)
» Evidence of Coverage
$42.67 None Yes None Yes 82

A few notes to help with the understanding of the chart above.
  • Plan Name: This is the official plan name from CMS
  • Deductible: This is the $250 deductible that was presented in the CMS Standard Plan. Many provider's plans do not have a deductible, however the premium may be higher.
  • Co-Pay Tiered Coverage: This is the portion of the plan where the provider and the beneficiary share the costs. Generally speaking, the beneficiary pays $500 out-of-pocket before moving to the Coverage Gap (Donut Hole) portion of the plan. Most of the plans provide a Tiered Drug List for this portion of the plan. In our chart, Yes: means that the plan uses a tiered drug list, therefore, drugs are organized into tiers and you pay a co-payment or co-insurance based on the tier. For Example: Tier 1 drugs: you pay a $5 co-payment, Tier 2: you pay $10, Tier 3: you pay $30. Each plan is different as to which drugs fall into which tiers and how much you pay per Tier. This information can only be found in the plans Formulary. (see link below to CMS) If None is shown in our chart, this means that a 25% co-insurance is applied (as in the CMS Standard Plan).
  • Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $2850 in drug costs (the Donut Hole). Many provider's plans cover the costs that fall into this category for an additional premium. In our chart, you will see one of the following None: you must pay the $2850; Generics Only: Generics are covered, but you must pay for Brand Drugs up to $2850; Generic & Brand Drugs: Both are covered by the plan.
  • Mail Order: Does the plan permit mail order drugs (remember: only drugs purchased in the U.S. can be covered in the plan).
  • Number of the Top 100 Drugs Covered: This column is to give you a feeling for the completeness of the plan. However, it is important to take a look at the formulary for your plan to be sure that your specific drugs are covered.


Please note: The above plan information came from CMS in October 2005.





Last updated on: 10/01/2006



Tips & Disclaimers
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.