AARP MedicareRx Preferred (PDP) California Medicare Part D Plan S5820-031

AARP MedicareRx Preferred California Medicare Part D Plan S5820-031-CAAARP MedicareRx Preferred for California is an approved Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other beneficiaries on Medicare living in California. 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.

The monthly premium (payment) is $57.90. It features a $0.00 deductible. There are more cost related details on 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 California, AARP MedicareRx Preferred 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.

The monthly premium is $57.90 ($694.80 paid annually), and 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 $320 per year in 2015) that must be paid before your prescription coverage assistance kicks in.

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”).

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

Coverage Details

AARP MedicareRx Preferred for California seniors comes with an initial coverage limit (ICL) of $2,960. The deductible on this plan is $0.00 (annual). ICL is calculated based on the full retail cost of prescriptions, not what you or the plan pays. 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 a zero dollar deductible. That means you receive prescription coverage assistance on day one (first dollar coverage).

AARP MedicareRx Preferred Initial Coverage Limit

The ICL is the same for all California 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, the insurance carrier. You each pay your share until $2,960 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 California.

Medicare Part D Coverage Gap (Donut Hole)

When you fall into the coverage gap, or donut hole as many people call it, you are basically uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap will all depend on your prescriptions. Most seniors never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.

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 with AARP MedicareRx Preferred

Some plans offer additional gap coverage. UnitedHealthcare does not offer additional coverage with the AARP MedicareRx Preferred PDP in California. 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 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$3.00698 Non-Preferred Generics
3$40.001120 Preferred Brand Drugs
4$85.001067 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 California 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 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 catalog is maintained by David Bynon and was last updated on 9/13/2015. CMS File Date: October 15, 2014.

About UnitedHealthcare

For more information, download the Summary of Benefits AARP MedicareRx Preferred (PDP) Medicare Part D Plan S5820-031 Summary of Benefits for California, visit the UnitedHealthcare website, or call UnitedHealthcare at N/A.