AARP Medicare Rx Preferred from UHC (PDP)
Contract S5921, plan 406, segment 0 · offered by UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY · CMS PDP Region 25 (Montana).
Plan features
| Monthly premium | $140.20 |
|---|---|
| Annual deductible | $130.00Tier 1 and 2 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,593 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Montana | at least 4,27216 counties suppressed by CMS (under 11 enrollees) |
| Members nationally | 32,893 |
| Member services | (866)870-3470TTY 711 |
| Pharmacy search | AARPMedicarePlans.com |
| BIN / PCN | 610097 / 9999See BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 2 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5921 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $5.00 | 267 |
| Tier 2 | $10.00 | 632 |
| Tier 3 | 18% | 1,040 |
| Tier 4 | 34% | 952 |
| Tier 5 | 31% | 702 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $5.00 | $13.00 | n/a | $15.00 | $39.00 | $0.00 |
| Tier 2: Generic | $10.00 | $18.00 | n/a | $30.00 | $54.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $5.00 | $13.00 | n/a | $15.00 | $39.00 | $0.00 |
| Tier 2: Generic | $10.00 | $18.00 | n/a | $30.00 | $54.00 | $0.00 |
| Tier 3: Preferred Brand | 18% | 18% | n/a | 18% | 18% | 18% |
| Tier 4: Non-Preferred Drug | 34% | 39% | 34% | n/a | n/a | n/a |
| Tier 5: Specialty Tier | 31% | 31% | 31% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Plan facts come from the CMS quarterly prescription drug plan public use files.