AARP MedicareRx Preferred Pennsylvania Medicare Part D Plan S5820-005

AARP MedicareRx Preferred  Medicare prescription drug plan for Pennsylvania SeniorsAARP MedicareRx Preferred for Pennsylvania is Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other Medicare beneficiaries in Pennsylvania. According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is Average, and rated it 3.0 out of 5.0 stars.

The monthly premium is $59.60. It features a $0.00 deductible. There are more cost related details in the premium section on this page. You can see your share at the pharmacy in the co-pay section, or learn more about the coverage in the coverage section.

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Cost Details

AARP MedicareRx Preferred does not pay all costs; it's a cost sharing plan. If you join, you share in the overall costs with UnitedHealthcare by paying a monthly premium, an annual deductible (if applicable), and copayments and/or coinsurance at your pharmacy.

Premium

This plan's annual premium is $715.20 ($59.60 paid monthly). It's priced as follows:

Basic Premium:$52.30
Supplemental Premium:$7.30
Full Premium:$59.60

Low-Income Subsidy

This plan is not available to people receiving low income subsidy (LIS) benefits.

Deductible

This plan has a $0.00 deductible (annual). 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

Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)

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 Pennsylvania Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

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

The ICL is the same for all Pennsylvania plans, but it changes from year-to-year. If you enroll in AARP MedicareRx Preferred you share the cost of all covered medications with UnitedHealthcare. You each pay your share until $3310.00 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Pennsylvania.

Coverage Gap (aka, Donut Hole)

When you reach the coverage gap, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it is possible to hit it quickly if you have expensive long-term prescriptions.

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 Pennsylvania 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 PayMedications in Tier
1$5.00Preferred Generics
2$8.00Non-Preferred Generics
3$35.00Preferred Brand Drugs
440%Non-Preferred Brand Drugs
533%Specialty 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

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 ( 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.

Availability

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 Philadelphia, Allentown, Bethlehem, State College, Scranton, Wilkes-Barre, Altoona, Harrisburg, York, Erie, Reading, Lancaster, and all other towns and cities in Pennsylvania.

About UnitedHealthcare

For more information, download the Summary of Benefits (N/A), visit the UnitedHealthcare website, or call UnitedHealthcare at 800-850-6807.

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