Medicare Prescription Drug Plan Benefit Details in Plain Text |
The following Medicare Prescription Drug plan (PDP) benefits apply to the Express Scripts Medicare - Value (PDP) (S5660 - 123) in CMS Region 21, which includes all counties in LA. This plan is administered by MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY, 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 - Value (PDP) prescription drug benefit details in chart format
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Plan Premium |
The Express Scripts Medicare - Value (PDP) has a monthly premium of $27.00. That is $324.00 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full extra help, your monthly premium will be $0. 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 - Value (PDP) (S5660 - 123) in CMS Region 21 currently has 27,269 members, and 515,507 members in the Express Scripts Medicare - Value (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:
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Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan has a $405 deductible. So, you are 100% responsible for the first $405 in medication costs. After you have met the deductible, the Express Scripts Medicare - Value (PDP) will share the costs of your medications with you -- see cost-sharing below. $405 is the maximum deductible for 2018. 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 - Value (PDP) formulary (or drug list). There are 2931 drugs on the Express Scripts Medicare - Value (PDP) formulary. The Express Scripts Medicare - Value (PDP) does offer a mail order service. Click here to browse the Express Scripts Medicare - Value (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 $405, 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 - Value (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:
The Express Scripts Medicare - Value (PDP)’s Initial Coverage Limit is $3,820. 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 56% 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 15% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 65% 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 - Value (PDP)) offers No Coverage during the Coverage Gap phase. |