Health Net Orange Option 2 PDP for Arizona Seniors

AZ Health Net Orange Option 2 (PDP) is a Medicare prescription drug plan underwritten by Health Net for eligible residents of Arizona. The plan is approved by CMS for drug formulary 00012051, which has 4894 FDA approved medications. The monthly premium is $82.70 ($992.40 for a full 12 months) and the pharmacy deductible is $0.00 per year. That means you receive prescription coverage assistance on day one (first dollar coverage).

Arizona seniors, be aware that a few different circumstances may decrease or increase your actual premium. Specifically, if you qualify for Extra Help (full or partial), your premium will decrease. On the other hand, if you have a premium penalty, your premium will be slightly more.

Health Net Orange Option 2 Initial Coverage Phase

The Initial Coverage Phase (ICP) is your plan’s cost-sharing phase. During the ICP both you and your insurance provider share the cost of your prescription medications. This plan has no deductible so your initial coverage phase begins immediately.

Each medication is put into a tier within the plan’s formulary. This is simply a way for the insurer to manage cost-sharing. It’s important to note that every plan can put medications on any tier they deem suitable. This is not standardized, because it is based on cost and the various risk models used by the insurers.

The tiered prescription cost sharing (e.g., pharmacy co-pay) in Arizona with this plan is as follows:

The 2012 Initial Coverage Limit with Health Net Orange Option 2 is $2,930.00. This drug plan doesn't qualify for a no cost LIS premium.

Coverage Gap Phase

The Coverage Gap, also known as the Donut Hole is the phase of your Part D plan where you must pay all of your medication costs. Healthcare Reform offers some additional assistance. For 2012 your insurance carrier will pay 7% of your generic drug prescription costs for you while you are in the donut hole. Likewise, the brand-name drug pharmaceutical companies cover half (50%) of your brand-name drug prescription costs. These subsidies count toward your True Out of Pocket (TrOOP) costs.

Some Medicare Part D plans provide additional Coverage Gap assistance that covers you above and beyond the discounts mandated by the Healthcare Reform Act. It’s important to note that if you have prescriptions that are not covered under your plan’s Gap Coverage, you will still get the generic and brand name drug discounts listed above, even if the plan itself does not offer gap coverage.

Here's how the carrier defines the 'donut hole' gap coverage for this policy: Less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.50. Use our free Arizona donut hole calculator to estimate out-of-pocket expenses for your precscription drugs with this policy.

Plan Members

The number of Medicare recipients using the Health Net Orange Option 2 plan nationally is 19,226. In your area (CMS PDP region 28) there are a reported 1,677 seniors on this plan. That's based on the previous year's reporting information.