Medicare Part D Plan -

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Cost Details

You Pay the Premium + Deductible + Copayments

What You Pay Could Be Different

Coverage Details

is a PDP. At a minimum, must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:

  • are actuarially equivalent to the standard benefit; or
  • are enhanced, offering benefits in addition to the standard benefit.

Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.

Initial Coverage Limit

Coverage Gap (aka, Donut Hole)

Additional Gap Coverage

does not offer additional assistance in the coverage gap. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local 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 prescription drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:

Tier You PayMedications in Tier
1Preferred Generics
2Non-Preferred Generics
3Preferred Brand Drugs
4Non-Preferred Brand Drugs
5Specialty Drugs

IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you lookup your prescriptions in the plan's formulary.

Quality Rating

has an overall rating of out of 5 stars. This summary rating was assigned by the Centers for Medicare and Medicaid Services (CMS) based on the plan's previous year performance. It provides shoppers with an overall score on the drug plan's quality and performance across 3 broad categories:

  • Drug plan customer service ( stars): Includes handling of member appeals.
  • Member experience with the plan's drug services ( stars): Includes ratings of member satisfaction with the plan.
  • Drug safety and accuracy of drug pricing ( stars): Includes how accurate the plan's pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is considered safer and clinically recommended for their condition.

CMS gathers quality information from several sources, including member surveys, reviews of billing and other information that plans submit to Medicare, and other monitoring activities.


If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in , and all other towns and cities in .


For more information, download the Summary of Benefits (N/A), visit the website, or call at N/A.

This PDP information is maintained by and was last updated on .