- Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The plan name is followed by the health plan type
(HMO,
HMO-POS,
PPO,
PFFS, etc).
The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown
to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2.
Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your
search to just national plans.)
- CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.
This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.
- Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.
This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.
- Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.
This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.
- RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.
This category includes measures of how drug plans rate on the following areas:- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.
- Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.
- County: Medicare Advantage Plans are only available in specific county and in some cases only in part of a county. This field will note the county where the plan is available or in some cases, "Statewide" if the plan is available in every county. (Search Tip: You must enter your 5-digit ZIP Code in the criteria field to begin your search. We will determine your county from your ZIP code and only show appropriate plans.)
- Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
(Search Tip: If you have selected an amount in the "LIS Subsidy Amount" filed, the premium shown is the premium based on your Low-Income Subsidy selection. - Deductible: The standard CMS plan
initial deductible is $445.
Many Medicare plans do not have a deductible; however their plan premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible" field.) Some plans that have an annual deductible
exempt certain drug tiers from the deductible. For example, "Tier 1 exempt" may be shown. This would mean that
Tier 1 drugs purchased during the Deductible phase, would not fall into the deductible and would be charged the
Initial Coverage Phase tier 1 cost-sharing.
- Gap Coverage: In the CMS Standard Plan,
the beneficiary, or others on their behalf (e.g. the brand-name drug manufacturer discount), pay(s)
up to $5,184 in drug costs,
depending on your mix of generics and brand-name drugs.
The Healthcare Reform provides that for plan year 2021,
all formulary drugs will have at least a 75% discount in
the coverage gap (Donut Hole).
The Gap Coverage Types discussed in this section are
supplemental coverage your plan pays in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Rx Cov.: This plan does not include prescription drug coverage. You are 100% responsible for your medication costs. If you would like to see ONLY those plans that do include some type of prescription coverage, please select "Show only plans WITH Drug Coverage" in the "Prescription Drug Coverage" selector above (this is the default setting);
- No Gap Coverage: You receive the 75% Donut Hole Discount and pay up to $5,184 depending on your mix of generics and brand-name drugs, before exiting into Catastrophic Coverage. Read more...
- Yes: This plan offers some supplemental gap coverage in addition to the 75% Donut Hole Discount. See plan details for a description of the gap coverage. The description may read similar to: Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.
- Plan ID: This is the unique id for this particular plan.
- Copay / Coinsurance - Cost Sharing - This is what you
will pay for formulary drugs in 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. Plans can form their own tiers, so you should contact the plan or reference
their summary of benefits to find out what copays and limitations are associated with each
tier. 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.
(Search Tip: If you would like to reduce the plans shown to just plans that have a
tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0)
in the "Max. Co-pay Tier 1 (Generics)" field.)
* When the text, for example: select insulin pay $35 copay appears, this Part D plan may offer particular forms of insulin as part of the Senior Savings Model. The Senior Savings Model stipulates that some insulin will cost no more than $35 in the deductible, initial coverage, and coverage gap phases of your Part D plan. Please contact the drug plan for more details.
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)
- Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
- Plan’s Summary Star Rating - This is the overall star rating for the Medicare Part D plan. To learn more about the star ratings, please see our
Plan Quality Star Ratings.
- Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
- Members in This Plan ID (September 2021 figures) - This is the total number of members in this plan's service area (a "Plan ID" is a specific contract ID and plan ID, for example H1234-001).
The number of members for the selected county and the enrollment for the selected state are shown in addition to the plan ID enrollment on the plan details page. you can access the plan details by clicking the plan name, orange enroll options button, or the plan details icon.
- Initial Coverage Limit (ICL) - The
Initial Coverage Phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins.
The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost).
The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for 2021 is $4,130 and increases each year.
- Medicare Part B Giveback Amount - If the plan rebates a portion of the Medicare Part B premium back to plan members, the amount will be shown in this column. This is also called "Part B premium Buy-Down", "Part B premium reduction", or "Part B premium give-back".
- MOOP for Part A & B Benefits - MOOP is the Maximum Out-of-Pocket limit set by the Medicare Advantage Plan. The figure shown is the beneficiaries yearly maximum out of pocket cost-sharing expenditure (co-payments / co-insurance) for Medicare Parts A & B (NOT Part D - prescription drug cost-sharing).
Also see, What happens when I reach my Medicare Advantage plan maximum out of pocket limit (MOOP)?
N/A means that this plan does not actually offer health cost-sharing benefits. Example: a Medicare Savings Account (MSA).
- Health Plan Type - This the organization type for the Medicare Advantage Plan.
This could be Health Maintenance Organization
(HMO),
Preferred Provider Organization
(PPO), etc.
(Search Tip: If you would like to limit your search to a specific type of Medicare Advantage Plans, please select the health plan type in the "Type of Health Coverage" field.)
- SNP Eligibility Requirements - Special Needs Plans (SNPs) have an eligibility requirement whereas all other Medicare Advantage plans do not. (Search Tip: If you would like to limit your search to specific types of Special Needs Medicare Advantage Plans, please check the appropriate boxes in the "Special Needs Plans (SNP) Options" field.)
(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)
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, we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Medicare plan provider.