United American - Enhanced (PDP) North Carolina Medicare Part D Plan S5755-011

United American - Enhanced North Carolina Medicare Part D Plan S5755-011-NCUnited American - Enhanced for North Carolina is a prescription drug plan (Medicare Part D Plan) that's available to seniors in North Carolina on Medicare. The Centers for Medicare & Medicaid Services (CMS) evaluated this plan's previous year performance and rated it 3.5 out of 5 stars ("Average") for quality.

The monthly premium (payment) is $71.40. It features a $60.00 deductible. There are more cost related details on the premium page. You can see your share at the pharmacy on the co-pay page, or learn more about the coverage on the coverage page.

This plan does not qualify for the government's $0 LIS premium.

Premium Details

Like all Medicare Part D plans sold in North Carolina, United American - Enhanced is a cost sharing based prescription drug plan (PDP). With the United American - Enhanced PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays.

The monthly premium is $71.40 ($856.80 paid annually), and the annual deductible is $60.00. For 2015, the maximum Part D deductible is $320. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.

Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).

There are two situations that can change how much an North Carolina Medicare Part D plan costs you. If your income is low and you are accepted into the Extra Help program administered by Social Security, your premium could be lower. It's also possible that your premium could be higher due to a late entry penalty. Be sure to speak with an authorized North Carolina Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

United American - Enhanced for North Carolina seniors has a $2,960 initial coverage limit (ICL). The annual deductible is $60.00. The ICL calculation is based on the full retail cost of your prescriptions. In addition to the premium, you will make co-payments at your pharmacy. Visit the co-pay page to see the co-payment plan.

This Part D Plan has a $60.00 deductible. That means you will pay all of your prescription costs until you have spent $60.00, at which point the ICP cost sharing phase begins. The maximum deductible allowed changes each year. In 2015 the maximum is $320.

United American - Enhanced Initial Coverage Limit

Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the United American - Enhanced PDP, you share the cost of your prescriptions with United American Insurance Company, the insurer. You each pay your share until the amount spent at the pharmacy reaches $2,960. That's the initial coverage limit in North Carolina for plan year 2015. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.

Medicare Part D Coverage Gap (Donut Hole)

The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with United American - Enhanced all depends on your prescriptions. Most seniors never fall into the donut hole.

If you reach the ICL (most seniors don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you're in the gap. You get to the other side of the donut hole when you've spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.

Additional Gap Coverage with United American - Enhanced

The United American Insurance Company gap coverage with the United American - Enhanced PDP in North Carolina is: Yes. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local North Carolina Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.

Copayment & Coinsurance Details

In addition to the monthly premium and annual deductible, the United American - Enhanced prescription drug plan has copayments and/or coinsurances that you must pay when you pickup your medications. Here's the schedule for this plan:

Tier  Co-Pay AmountMedications in Tier
1$0.00494 Preferred Generics
2$7.001538 Non-Preferred Generics
3$37.00334 Preferred Brand Drugs
440%1940 Non-Preferred Brand Drugs
530%672 Specialty Drugs

The United American - Enhanced Medicare Part D plan uses United American Insurance Company formulary number 00015321, which covers 4978 generic and brand name drugs.

Compare Plans

Here are a few more PDPs available in North Carolina that deserve a look:

Availability

If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the United American - Enhanced prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Charlotte, Gastonia, Concord, Raleigh, Greensboro, High Point, Winston, Salem, Durham, Fayetteville, Cary, Wilmington, Ashville, Jacksonville, Chapel Hill, Rocky Mount, Burlington, Wilson and all other towns and cities in North Carolina.

This catalog is maintained by David Bynon and was last updated on 9/14/2015. CMS File Date: October 15, 2014.

About United American Insurance Company

For more information, download the Summary of Benefits Not Available, visit the United American Insurance Company website, or call United American Insurance Company at N/A.