AARP MedicareRx Preferred for California is a Medicare Part D prescription drug plan. It's approved by the Centers for Medicare and Medcaid Services (CMS) for people in California with Medicare benefits. CMS gave this plan a quality rating of 3.0 out of 5.0 stars (Average).
If you enroll in this plan you'll pay the $68.60 monthly premium, and there's a $0.00 annual deductible before cost sharing begins. For more information about the costs, refer to the premium section on this page. You also have co-payments when you pickup your prescriptions at the pharmacy. Be sure to look at the coverage section to make sure it fits your needs.
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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 $68.60 ($823.20 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
Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).
What You Pay Could Be Different
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 California 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
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the AARP MedicareRx Preferred PDP, you share the cost of your prescriptions with UnitedHealthcare. You each pay your share until the amount spent at the pharmacy reaches $3310.00. That's the initial coverage limit in California for plan year 2016. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
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.
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 California 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 ( 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 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 Los Angeles, Long Beach, Anaheim, San Francisco, Oakland, Hayward, Riverside, San Bernardino, Ontario, San Diego, Carlsbad, Chula Vista, Sacramento, Roseville, San Jose, Sunnyvale, Santa Clara, Fresno, Bakersfield, Oxnard, Thousand Oaks, Ventura, Sonoma, Napa, Stockton, Irvine, and all other towns and cities in California.
This PDP information is maintained by David Bynon and was last updated on .