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.

Cost Details

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.

Premium

The monthly premium is $59.60 ($715.20 paid annually). It breaks down 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

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

Most people pay the standard premium. However, if you qualify for Extra Help with your Medicare Part D plan due to your income, your premium may be lower or cost you nothing at all. But, if you did not enroll in a Part D plan as soon as you were first eligible, Medicare can impose a penalty and your premium will be higher. To get an exact rate for your situation, contact a Pennsylvania Medicare Insurance Agent.

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.

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

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 (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.

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 .