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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2015 Express Scripts Medicare - Choice (PDP)

Medicare Prescription Drug Plan Benefit Details in Plain Text
The following Medicare Prescription Drug plan (PDP) benefits apply to the Express Scripts Medicare - Choice (PDP) (S5660 - 213) in CMS Region 21, which includes all counties in LA.

This plan is administered by MEDCO CONTAINMENT LIFE INSURANCE COMPANY, a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here.
Click here to see the Express Scripts Medicare - Choice (PDP) prescription drug benefit details in chart format or email and view benefits chart

Plan Premium
The Express Scripts Medicare - Choice (PDP) has a monthly premium of $55.90. That is $670.80 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

Plan Membership and Plan Ratings
The Express Scripts Medicare - Choice (PDP) (S5660 - 213) in CMS Region 21 currently has 1,462 members, and 65,402 members in the Express Scripts Medicare - Choice (PDP) nationwide.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:
  • Customer Service Rating of 3 out of 5 stars
  • Member Experience Rating of 5 out of 5 stars
  • Drug Cost Information Accuracy Rating of 4 out of 5 stars
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $50 deductible. However, some formulary drug Tiers are excluded from the $50 deductible and have first dollar coverage (or a $0 deductible)—details coming soon. So, you are 100% responsible for the first $50 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Express Scripts Medicare - Choice (PDP) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2015 is $320, but this plan (Express Scripts Medicare - Choice (PDP)) has a $50. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.

The following information is about the Express Scripts Medicare - Choice (PDP) formulary (or drug list). There are 3612 drugs on the Express Scripts Medicare - Choice (PDP) formulary.

The Express Scripts Medicare - Choice (PDP) does offer a mail order service.

Click here to browse the Express Scripts Medicare - Choice (PDP) Formulary.
 
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $50, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Express Scripts Medicare - Choice (PDP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Preferred Generic) contains 417 drugs and has a co-payment of $1.00.
  • Tier 2 (Non-Preferred Generic) contains 1,631 drugs and has a co-payment of $5.00.
  • Tier 3 (Preferred Brand) contains 769 drugs and has a co-payment of $40.00.
  • Tier 4 (Non-Preferred Brand) contains 431 drugs and has a co-insurance of 48% of the drug cost.
  • Tier 5 (Specialty Tier) contains 364 drugs and has a co-insurance of 31% of the drug cost.
    •  
Click here to browse the Express Scripts Medicare - Choice (PDP) Formulary.

The Express Scripts Medicare - Choice (PDP)’s Initial Coverage Limit is $2,960. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole).

The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 35% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 50% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 55% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Express Scripts Medicare - Choice (PDP)) offers No Coverage during the Coverage Gap phase.





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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
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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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  • 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.
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