Humana Walmart Rx Plan for Arizona is Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other Medicare beneficiaries in Arizona. According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is Average, and rated it 3.5 out of 5.0 stars.
If you enroll in this plan you'll pay the $18.40 monthly premium, and there's a $360.00 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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Humana Walmart Rx Plan does not pay all costs; it's a cost sharing plan. If you join, you share in the overall costs with Humana Insurance Company by paying a monthly premium, an annual deductible (if applicable), and copayments and/or coinsurance at your pharmacy.
This plan's annual premium is $220.80 ($18.40 paid monthly). It's priced as follows:
This plan is not available to people receiving low income subsidy (LIS) benefits.
This plan has a $360.00 deductible (annual). For 2016, the maximum Part D deductible is $360. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.
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 situations that can change your monthly premium. If your income is low and you are accepted into the Extra Help program administered by Social Security, your premium could be lower. It's also possible that your premium could be higher due to a late entry penalty. Be sure to speak with an authorized Arizona Medicare Insurance Agent to get an exact quote for your situation.
Humana Walmart Rx Plan is a Enhanced Alternative PDP. At a minimum, Humana Insurance Company 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
It's important to understand the initial coverage limit (ICL) and how it applies to you in Arizona. The ICL is where you share the cost of your prescriptions with the insurance company. You and Humana Insurance Company each pay your share until you reach a total of $3310.00 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.
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 Humana Walmart Rx Plan 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
Humana Walmart Rx Plan 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 Arizona 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 Humana Walmart Rx Plan 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||20%||Preferred Brand Drugs|
|4||35%||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.
Humana Walmart Rx Plan has an overall rating of 3.5 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 Humana Walmart Rx Plan prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Scottsdale, Phoenix, Peoria, Surprise, Mesa, Tucson, Tempe, Yuma, Avondale, Buckeye, Chandler, Goodyear, Gilbert, Lake Havasu City, Flagstaff, Bullhead City, and all other towns and cities in Arizona.
About Humana Insurance Company
This PDP information is maintained by David Bynon and was last updated on .