AARP MedicareRx Preferred (PDP) Pennsylvania Medicare Part D Plan S5820-005

AARP MedicareRx Preferred Pennsylvania Medicare Part D Plan S5820-005-PAAARP MedicareRx Preferred for Pennsylvania is an approved Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other beneficiaries on Medicare living in Pennsylvania. According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is "Above Average". Medicare rated it 4.0 out of 5.0 stars.

If you enroll in this plan you'll pay the $49.70 monthly premium, and there's a $0.00 annual deductible before cost sharing begins. For more information about the costs, refer to the premium page. You can check out the coverage information on the coverage page, or click on the copayments page to see your costs at the pharmacy.

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

Premium Details

Like all Medicare Part D plans sold in Pennsylvania, AARP MedicareRx Preferred is a cost sharing based prescription drug plan (PDP). If you enroll in the AARP MedicareRx Preferred PDP, you share in the overall costs with the insurer by paying a monthly premium, an annual deductible (if applicable), and copayments at your pharmacy.

The premium on this plan is $596.40 ($49.70 per month). It comes with a $0.00 annual deductible. A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $320 per year in 2015) that must be paid before your prescription coverage assistance kicks in.

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.

For all seniors on Medicare, there are two conditions that could affect how much you pay for this plan. If you qualify for the Social Security Extra Help program your premium will generally be lower. Also, if you enrolled late the Centers for Medicare and Medicaid Service may impose a premium penalty. Contact your local Pennsylvania Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

AARP MedicareRx Preferred for Pennsylvania seniors has a $2,960 initial coverage limit (ICL). The annual deductible is $0.00. The ICL calculation is based on the full retail cost of your prescriptions. All Medicare prescription drug plans have co-pay requirements. The co-pay is the amount you pay when you fill your prescriptions. The co-payment schedule for this plan is on the co-pay page.

This PDP has no deductible ($0.00) so your initial coverage phase begins immediately.

AARP MedicareRx Preferred Initial Coverage Limit

It's important to understand the initial coverage limit (ICL) and how it applies to you in Pennsylvania. The ICL is where you share the cost of your prescriptions with the insurance company. You and the carrier (UnitedHealthcare) each pay your share until you reach a total of $2,960 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.

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 AARP MedicareRx Preferred all depends on your prescriptions. Most seniors never fall into the donut hole.

In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $4,550 (excluding premiums and expense paid by insurance) minus a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs. Once you reach $4,550 in out-of-pocket expenses, you're out of the coverage gap. At this point you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.

Additional Gap Coverage with AARP MedicareRx Preferred

Some plans offer additional gap coverage. UnitedHealthcare does not offer additional coverage with the AARP MedicareRx Preferred PDP in Pennsylvania. 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 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$2.0063 Preferred Generics
2$5.00698 Non-Preferred Generics
3$40.001120 Preferred Brand Drugs
4$80.001067 Non-Preferred Brand Drugs
533%679 Specialty Drugs

The AARP MedicareRx Preferred Medicare Part D plan uses UnitedHealthcare formulary number 00015002, which covers 3627 generic and brand name drugs.

Compare Plans

Here are a few more PDPs available in Pennsylvania 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 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.

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

About UnitedHealthcare

For more information, download the Summary of Benefits AARP MedicareRx Preferred (PDP) Medicare Part D Plan S5820-005 Summary of Benefits for Pennsylvania, visit the UnitedHealthcare website, or call UnitedHealthcare at N/A.