AARP MedicareRx Preferred California Medicare Part D Plan S5820-031

AARP MedicareRx Preferred  Medicare prescription drug plan for California SeniorsAARP 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).

The monthly premium is $68.60. 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

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 $823.20 ($68.60 paid monthly). It's priced as follows:

Basic Premium:$63.90
Supplemental Premium:$4.70
Full Premium:$68.60

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

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

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 California 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

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)

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.

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 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 PayMedications in Tier
1$4.00Preferred Generics
2$10.00Non-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 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.

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 .