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2019 Medicare Prescription Drug Plan Benefit Details for the Express Scripts Medicare - Saver (PDP)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2019 Medicare Prescription Drug Plan Details
Medicare Plan Name:Express Scripts Medicare - Saver (PDP)
   by Express Scripts Medicare
State:Colorado
Plan ID:S5660 - 243 - 0     Click to see other plans
Member Services:1-800-758-4574 TTY users 1-800-716-3231
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Express Scripts Medicare - Saver (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$24.00 (see Plan Premium Details below)
Annual Deductible:$415 (Tier 1 and 2 excluded from the Deductible.)
$0 Premium if LIS Benefits?No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.)
Annual Initial Coverage Limit (ICL):$3,820
Drug Benefit Type ❔Enhanced Alternative (EA)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:2,906 drugsBrowse the Express Scripts Medicare - Saver (PDP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$1.00$4.0018%33%25%
• Number of Drugs per
  Tier:		101809639898459
Plan Offers Mail Order?Yes
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Colorado:5,541 members     (CMS Region 27)
Number of Members enrolled in this plan nationally:214,812 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 4 out of 5 Stars.
• Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$24.00$19.30$4.70
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$4.70$9.50$14.30$19.20




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