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CVS Caremark Complete (PDP) (S5601-103-0)
Tier 1 (175)
Tier 2 (1731)
Tier 3 (887)
Tier 4 (225)
Tier 5 (183)
Requires Prior Authorization:
Yes No Show either
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2010 Medicare Part D Plan Formulary Information
CVS Caremark Complete (PDP) (S5601-103-0)
Benefit Details  
The CVS Caremark Complete (PDP) (S5601-103-0)
Formulary Drugs Starting with the Letter N

in CMS PDP Region 32 which includes: CA
Drugs Starting with Letter N

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
NABUMETONE 500MG TABLET   2 Generic Tier $7.50$19.00None
NABUMETONE 750MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL 160MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL 20MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL 40MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL 80MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL-BENDROFLUMETHIAZIDE 40-5MG TABLET   2 Generic Tier $7.50$19.00None
NADOLOL-BENDROFLUMETHIAZIDE 80-5MG TABLET   2 Generic Tier $7.50$19.00None
NAFAZAIR 0.1% EYE DROPS   2 Generic Tier $7.50$19.00None
NAFCILLIN FOR INJECTION 1 GM/ML   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAFCILLIN FOR INJECTION 10GM/ML 1 VIAL   2 Generic Tier $7.50$19.00None
NAGLAZYME 5MG/5ML VIAL   5 Specialty Tier 33%N/ANone
NALBUPHINE 10MG/ML VIAL   2 Generic Tier $7.50$19.00None
NALBUPHINE 20MG/ML VIAL   2 Generic Tier $7.50$19.00None
NALOXONE 1MG/ML SYRINGE   2 Generic Tier $7.50$19.00None
NALOXONE HCL INJECTION 0.4MG 10 X 1ML CTG   2 Generic Tier $7.50$19.00None
NALTREXONE HCL 50MG TABLET 100 BLPK   2 Generic Tier $7.50$19.00None
NAMENDA 10MG TABLET   3 Preferred Brand Tier $39.00$98.00None
NAMENDA 10MG/5ML SOLUTION   3 Preferred Brand Tier $39.00$98.00None
NAMENDA 5-10MG TITRATION PK   3 Preferred Brand Tier $39.00$98.00None
NAMENDA 5MG TABLET   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAPROXEN 125MG/5ML SUSPEN   2 Generic Tier $7.50$19.00None
NAPROXEN 375MG TABLET EC   2 Generic Tier $7.50$19.00None
NAPROXEN 500MG TABLET EC   2 Generic Tier $7.50$19.00None
NAPROXEN SODIUM 275MG TABLET (100 CT)   2 Generic Tier $7.50$19.00None
NAPROXEN SODIUM 550MG TABLET (500 CT)   2 Generic Tier $7.50$19.00None
NAPROXEN TABLET 375MG (500 CT)   1 Value Generic Tier $2.50$5.00None
NARDIL 15MG TABLET   3 Preferred Brand Tier $39.00$98.00None
NASACORT AQ AER 55MCG/AC   3 Preferred Brand Tier $39.00$98.00Q:17
/25Days
NASONEX 50MCG NASAL SPRAY   4 Non-Preferred Brand Tier $98.00$270.00Q:34
/25Days
NATACYN EYE DROPS   3 Preferred Brand Tier $39.00$98.00None
NAVANE 20MG CAPSULE   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NECON 0.5/35-28 TABLET   2 Generic Tier $7.50$19.00None
NECON 1-0.05MG TABLET   2 Generic Tier $7.50$19.00None
NECON 1/35-28 TABLET   2 Generic Tier $7.50$19.00None
NECON 10/11-28 TABLET   3 Preferred Brand Tier $39.00$98.00None
NECON 7 DAYS X 3 TABLET   2 Generic Tier $7.50$19.00None
NEFAZODONE HCL 150MG TABLET (60 CT)   2 Generic Tier $7.50$19.00None
NEFAZODONE HCL 250MG TABLET   2 Generic Tier $7.50$19.00None
NEFAZODONE HCL 50MG TABLET   2 Generic Tier $7.50$19.00None
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT   2 Generic Tier $7.50$19.00None
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT   2 Generic Tier $7.50$19.00None
NEO/POLY/DEX OIN 0.1% OP   1 Value Generic Tier $2.50$5.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT   2 Generic Tier $7.50$19.00None
NEOMYCIN AND POLYMYXIN B SULFATES SOLUTION FOR IRRIGATION 40MG/20000UNT   2 Generic Tier $7.50$19.00None
NEOMYCIN SULFATE 500MG TABLET   2 Generic Tier $7.50$19.00None
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT   1 Value Generic Tier $2.50$5.00None
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS   2 Generic Tier $7.50$19.00None
NEOMYCIN/POLYMY/DEXA EYE DROPS 3.5MG/1ML   1 Value Generic Tier $2.50$5.00None
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M   2 Generic Tier $7.50$19.00None
NEOMYCIN/POLYMY/HYDRO OTIC SUS   2 Generic Tier $7.50$19.00None
NEORAL 100MG GELATN CAPSULE   3 Preferred Brand Tier $39.00$98.00P
NEORAL 100MG/ML SOLUTION   3 Preferred Brand Tier $39.00$98.00P
NEORAL 25MG GELATIN CAPSULE   3 Preferred Brand Tier $39.00$98.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEPHRAMINE SOLUTION FOR INJECTION   3 Preferred Brand Tier $39.00$98.00P
NEULASTA 6MG/0.6ML SYRINGE   5 Specialty Tier 33%N/AP
NEUPOGEN 300MCG/ML VIAL   5 Specialty Tier 33%N/AP
NEUPOGEN INJECTION 300MCG/0.5ML 0.5ML SYR   5 Specialty Tier 33%N/AP
NEUPOGEN INJECTION 480MCG/0.8ML 10 X 0.8ML SYR   5 Specialty Tier 33%N/AP
NEURONTIN 250MG/5ML TUBEX   3 Preferred Brand Tier $39.00$98.00Q:2350
/25Days
NEXAVAR TABLETS 200MG 120 BOT   5 Specialty Tier 33%N/ANone
NEXIUM 10MG PACKET   3 Preferred Brand Tier $39.00$98.00Q:90
/365Days
NEXIUM 20MG CAPSULE   3 Preferred Brand Tier $39.00$98.00Q:90
/365Days
NEXIUM 20MG SUSP FOR RECON DELAYED REL. IN A PACKET   3 Preferred Brand Tier $39.00$98.00Q:90
/365Days
NEXIUM 40MG CAPSULE   3 Preferred Brand Tier $39.00$98.00Q:90
/365Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEXIUM 40MG SUSP FOR RECON DELAYED REL. IN A PACKET   3 Preferred Brand Tier $39.00$98.00Q:90
/365Days
NEXIUM IV 20MG VIAL   4 Non-Preferred Brand Tier $98.00$270.00None
NEXIUM IV 40MG VIAL   4 Non-Preferred Brand Tier $98.00$270.00None
NIACOR 500MG TABLET   2 Generic Tier $7.50$19.00None
NIASPAN 1000MG TABLET (90 CT)   3 Preferred Brand Tier $39.00$98.00None
NIASPAN ER 500MG TABLET (90 CT)   3 Preferred Brand Tier $39.00$98.00None
NIASPAN ER 750MG TABLET (90 CT)   3 Preferred Brand Tier $39.00$98.00None
NICARDIPINE HYDROCHLORIDE CAPSULES 20MG 100 BOT   2 Generic Tier $7.50$19.00None
NICARDIPINE HYDROCHLORIDE CAPSULES 30MG 500 BOT   2 Generic Tier $7.50$19.00None
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL   3 Preferred Brand Tier $39.00$98.00None
NIFEDIAC CC 30MG TABLET SA   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIFEDIAC CC 60MG TABLET SA   2 Generic Tier $7.50$19.00None
NIFEDIAC CC 90MG TABLET SA   2 Generic Tier $7.50$19.00None
NIFEDICAL XL 30MG TABLET SR OSMOTIC PUSH 24HR   2 Generic Tier $7.50$19.00None
NIFEDICAL XL 60MG TABLET SR OSMOTIC PUSH 24HR   2 Generic Tier $7.50$19.00None
NIFEDIPINE 10MG CAPSULE   2 Generic Tier $7.50$19.00None
NIFEDIPINE ER 30MG TABLET SA   2 Generic Tier $7.50$19.00None
NIFEDIPINE ER 60MG TABLET SA   2 Generic Tier $7.50$19.00None
NIFEDIPINE ER 90MG TABLET SA   2 Generic Tier $7.50$19.00None
NILANDRON 150MG TABLET   3 Preferred Brand Tier $39.00$98.00None
NIMODIPINE 30MG CAPSULE   2 Generic Tier $7.50$19.00None
NISOLDIPINE 20MG TB24   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NISOLDIPINE 30MG TB24   2 Generic Tier $7.50$19.00None
NISOLDIPINE 40MG TB24   2 Generic Tier $7.50$19.00None
NITRO-DUR 0.3MG/HR PATCH   3 Preferred Brand Tier $39.00$98.00None
NITRO-DUR 0.8MG/HR PATCH INST.   3 Preferred Brand Tier $39.00$98.00None
NITROFURANTOIN 100MG CAPSULE (100 CT)   2 Generic Tier $7.50$19.00None
NITROFURANTOIN MCR 50MG CAP   2 Generic Tier $7.50$19.00None
NITROGLYCERIN .2MG/HR PATCH   2 Generic Tier $7.50$19.00None
NITROGLYCERIN .4MG/HR PATCH   2 Generic Tier $7.50$19.00None
NITROGLYCERIN .6MG/HR PATCH   2 Generic Tier $7.50$19.00None
NITROGLYCERIN 5MG/ML VIAL   2 Generic Tier $7.50$19.00None
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NITROLINGUAL SPR PUMPSPRA   3 Preferred Brand Tier $39.00$98.00None
NITROSTAT 0.3MG TABLET SL   3 Preferred Brand Tier $39.00$98.00None
NITROSTAT 0.4MG TABLET SL   3 Preferred Brand Tier $39.00$98.00None
NITROSTAT 0.6MG TABLET SL   3 Preferred Brand Tier $39.00$98.00None
NIZATIDINE 150MG CAPSULE   2 Generic Tier $7.50$19.00None
NIZATIDINE 300MG CAPSULE   2 Generic Tier $7.50$19.00None
NORA-BE 0.35MG TABLET   2 Generic Tier $7.50$19.00None
NORDITROPIN 15MG/1.5ML CRTG   5 Specialty Tier 33%N/AP
NORDITROPIN 5MG/1.5ML CRTG   5 Specialty Tier 33%N/AP
NORDITROPIN NORDIFLEX 10MG/1.5   5 Specialty Tier 33%N/AP
NORDITROPIN NORDIFLEX 15MG/1.5   5 Specialty Tier 33%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORDITROPIN NORDIFLEX 5MG/1.5   5 Specialty Tier 33%N/AP
NORETHINDRONE 5MG TABLET   2 Generic Tier $7.50$19.00None
NORMOSOL -R INJ /D5W   2 Generic Tier $7.50$19.00None
NORMOSOL-M AND DEXTROSE 5%   2 Generic Tier $7.50$19.00None
NORMOSOL-R PH 7.4 IV SOLUTION   3 Preferred Brand Tier $39.00$98.00None
NORPACE CR 100MG CAPSULE SA   3 Preferred Brand Tier $39.00$98.00None
NORTREL .035-1MG TABLET 21DAY BLPK   2 Generic Tier $7.50$19.00None
NORTREL 0.035-0.5MG TABLET 28DAY BLPK   2 Generic Tier $7.50$19.00None
NORTREL 1-0.035MG TABLET 28DAY   2 Generic Tier $7.50$19.00None
NORTREL 7 DAYS X 3 TABLET   2 Generic Tier $7.50$19.00None
NORTRIPTYLINE 10MG/5ML SOL   2 Generic Tier $7.50$19.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORTRIPTYLINE HCL 10MG CAPSULE   1 Value Generic Tier $2.50$5.00None
NORTRIPTYLINE HCL 25MG CAP   1 Value Generic Tier $2.50$5.00None
NORTRIPTYLINE HCL 50MG CAPSULE   1 Value Generic Tier $2.50$5.00None
NORTRIPTYLINE HCL 75MG CAPSULE   1 Value Generic Tier $2.50$5.00None
NORVIR 100MG SOFTGEL CAP   3 Preferred Brand Tier $39.00$98.00None
NORVIR 80MG/ML ORAL SOLUTION   3 Preferred Brand Tier $39.00$98.00None
NOVAMINE AMINO ACIDS INJECTION 15%   2 Generic Tier $7.50$19.00P
NOVAREL INJ 10000UNT   2 Generic Tier $7.50$19.00P
NOVOLIN 70/30 100U/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
NOVOLIN 70/INJ 30 INNLT   3 Preferred Brand Tier $39.00$98.00None
NOVOLIN N 100U/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NOVOLIN N INJ INNOLET   3 Preferred Brand Tier $39.00$98.00None
NOVOLIN R 100U/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
NOVOLIN R 100UNIT/ML INNOLET   3 Preferred Brand Tier $39.00$98.00None
NOVOLOG 100U/ML VIAL   3 Preferred Brand Tier $39.00$98.00None
NOVOLOG FLEXPEN SYRINGE   3 Preferred Brand Tier $39.00$98.00None
NOVOLOG MIX 70/30 SYRINGE 70-30U/ML   3 Preferred Brand Tier $39.00$98.00None
NOVOLOG MIX 70/30 VIAL   3 Preferred Brand Tier $39.00$98.00None
NULYTELY WITH FLAVOR PACKS POWDER FOR SOLUTION 420;1.48;MG;MG;GM; 4 L BOT   4 Non-Preferred Brand Tier $98.00$270.00None
NUVARING 0.12-0.015 RING VAGINAL   3 Preferred Brand Tier $39.00$98.00None
NYSTATIN 100000U/G POWDER   2 Generic Tier $7.50$19.00None
NYSTATIN 100000U/GM CREAM   1 Value Generic Tier $2.50$5.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NYSTATIN OINTMENT 100000UNT/GM 15 GM TUBE   2 Generic Tier $7.50$19.00None
NYSTATIN ORAL SUSPENSION 100000U 473ML BOT   2 Generic Tier $7.50$19.00None
NYSTATIN TABLET 500000U (100 CT)   2 Generic Tier $7.50$19.00None
NYSTATIN/TRIAMCINOLONE CRM   2 Generic Tier $7.50$19.00None
NYSTATIN/TRIAMCINOLONE OINT 10000UNT/1MG   2 Generic Tier $7.50$19.00None
NYSTOP 100000U/GM POWDER   2 Generic Tier $7.50$19.00None

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D CVS Caremark Complete (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2830) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2010 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • 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.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • 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.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • 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.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • 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.