On this page we help consumers: Compare Express Scripts Medicare Value, a 2020 Medicare Prescription Drug Plan (PDP) available in Maine for $29.20/month with a $435.00 deductible, with all Medicare Part D Plans in ME.
The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 3.0 out of 5 stars (Average) for quality.
These are the areas of the plan that are important to compare and review:
- Premium & Deductible: The premium is the amount you will pay monthly. Plud, many plans have an annual deductible that must be met before cost sharing begins.
- Coverage Phases: Part D plans have an initial coverage limit, followed by a coverage gap, and then catastropic coverage. Some plans offer some coverage in the gap.
- Co-pays & Co-insurance: If you have regular prescriptions, it's critical to verify that your drugs are covered and to know what you will pay at the pharmacy.
- CMS Ratings: Important measurements across 4 different areas that will help you understand how well this plan will care for you.
Express Scripts Medicare Value is a cost sharing prescription drug plan (PDP). There are three distinct costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium on this PDP is $350.40 ($29.20 per month), and breaks down as follows:
This plan qualifies for the full, low income subsidy benefit. The following table details subsidised premium amounts:
|Subsidy Level||Monthly Premium|
There is a $435.00 annual deductible with this PDP.
For 2020, the maximum Part D deductible is $435. 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
Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)
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 Maine Medicare Insurance Agent to get an exact quote for your situation.
Express Scripts Medicare Value is a Basic PDP. At a minimum, Express Scripts Medicare 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 Maine plans, but it changes from year-to-year. If you enroll in Express Scripts Medicare Value you share the cost of all covered medications with Express Scripts Medicare. You each pay your share until $4020.00 (retail spending) 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 Maine.
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 Express Scripts Medicare Value all depends on your prescriptions. Most seniors never fall into the donut hole.
When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (75% off of both brand-name drugs and generics). You continue to pay this until your out-of-pocket costs reach $6,350. 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 Express Scripts Medicare pays.
Additional Gap Coverage
Express Scripts Medicare Value 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 Maine 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 Express Scripts Medicare Value 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:
|1 (Preferred Generic)||$1.00 copay||$9.00 copay|
|2 (Generic)||$3.00 copay||$12.00 copay|
|3 (Preferred Brand)||$25.00 copay||$35.00 copay|
|4 (Non-Preferred Drug)||39%||41%|
|5 (Specialty Tier)||25%||25%|
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you look up your prescriptions in the plan's formulary.
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates prescription drug plans in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this Express Scripts Medicare plan.
|2020 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Contact Express Scripts Medicare
Here's the new member contact information for Express Scripts Medicare:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part D program on www.medicare.gov or the Wikipedia page. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the Express Scripts Medicare Value prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Portland, Lewiston, Bangor, South Portland, Auburn, Biddeford, Sanford, and all other towns and cities in Maine.