AARP MedicareRx Preferred for New Jersey is a prescription drug plan (PDP) that's available to seniors in New Jersey on Medicare. The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 3.0 out of 5 stars (Average) for quality.
If you choose to enroll you will pay $65.80 per month (the premium). In addition to the premium there is a $0.00 annual deductible. You can find out more about the costs associated with this plan in the premium section of this page. You can check out the coverage information in the coverage secrion, or look at the copayments section to see your costs at the pharmacy.
This is a cost sharing based prescription drug plan (PDP). With the AARP MedicareRx Preferred PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays and/or co-insurance.
The monthly premium is $65.80 ($789.60 paid annually). It breaks down as follows:
This plan is not available to people receiving low income subsidy (LIS) benefits.
The annual deductible is $0.00. A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $360 per year in 2016) that must be paid before your prescription coverage assistance kicks in.
You Pay the Premium + Deductible + Copayments
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
What You Pay Could Be Different
There are two situations that can change your monthly premium. 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 New Jersey Medicare Insurance Agent to get an exact quote for your situation.
AARP MedicareRx Preferred is a Enhanced Alternative PDP. At a minimum, UnitedHealthcare 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
It's important to understand the initial coverage limit (ICL) and how it applies to you in New Jersey. The ICL is where you share the cost of your prescriptions with the insurance company. You and UnitedHealthcare each pay your share until you reach a total of $3310.00 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.
Coverage Gap (aka, 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 AARP MedicareRx Preferred all depends on your prescriptions. Most seniors never fall into the donut hole.
When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (47.5% off of brand-name drugs and 28% off generics). You continue to pay this until your out-of-pocket costs reach $4,550. At this point Medicare takes over by giving you catastrophic coverage. The $4,550 out-of-pocket figure does not include your monthly premiums or what UnitedHealthcare pays.
Additional Gap Coverage
AARP MedicareRx Preferred 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 New Jersey 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 AARP MedicareRx Preferred 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 Pay||Medications in Tier|
|3||$35.00||Preferred Brand Drugs|
|4||40%||Non-Preferred Brand 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.
AARP MedicareRx Preferred has an overall rating of 3.0 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 (5.0 stars): Includes handling of member appeals.
- Member experience with the plan's drug services (3.0 stars): Includes ratings of member satisfaction with the plan.
- Drug safety and accuracy of drug pricing (2.0 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 AARP MedicareRx Preferred prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Newark, Jersey City, Camden, Paterson, Elizabeth, Edison, Woodbridge, Lakewood, Toms River, Hamilton, Trenton, Clifton, Cherry Hill, Passaic, Middletown, Union City, Old Bridge, Gloucester City, East Orange, Bayonne, Franklin, North Bergen, Vineland, Union, Piscataway, New Brunswick, Wayne, Irvington, Parsippany, and all other towns and cities in New Jersey.
This PDP information is maintained by David Bynon and was last updated on .