On this page we help consumers: Compare Express Scripts Medicare Choice, a 2020 Medicare Prescription Drug Plan (PDP) available in Maryland for $74.70/month with a $250.00 deductible, with all Medicare Part D Plans in MD.
Express Scripts Medicare Choice is a 3.0 Star Medicare Part D Plan for Medicare Beneficiaries in Maryland
CMS gave this prescription drug plan a quality rating of 3.0 out of 5.0 stars (Average).
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 Choice does not pay all costs; it's a cost sharing plan. If you join, you share in the overall costs with Express Scripts Medicare by paying a monthly premium, an annual deductible (if applicable), and copayments and/or coinsurance at your pharmacy.
This plan's annual premium is $896.40 ($74.70 paid monthly). It's priced as follows:
This plan is not available to people receiving full Low Income Subsidy (LIS) benefits.
This plan has a $250.00 deductible (annual).
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
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
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 Maryland Medicare Insurance Agent to get an exact quote for your situation.
Express Scripts Medicare Choice is a Enhanced 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 Maryland plans, but it changes from year-to-year. If you enroll in Express Scripts Medicare Choice 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 Maryland.
Coverage Gap (aka, Donut Hole)
When you reach the coverage gap, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it is possible to hit it quickly if you have expensive long-term prescriptions.
In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $6,350 (excluding premiums and expense paid by insurance) minus a 75% discount on both brand-name prescription drugs and generics. Once you reach $6,350 in out-of-pocket expenses, you're out of the coverage gap. At this point, you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.
Additional Gap Coverage
Express Scripts Medicare Choice offers some additional assistance in the coverage gap. See the plan's Summary of Benefits for details. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Maryland 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 Choice 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)||$2.00 copay||$10.00 copay|
|2 (Generic)||$7.00 copay||$20.00 copay|
|3 (Preferred Brand)||$42.00 copay||$47.00 copay|
|4 (Non-Preferred Drug)||48%||50%|
|5 (Specialty Tier)||28%||28%|
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.
Express Scripts Medicare Choice can be used in conjunction with Original Medicare (Parts A and B), and all Medicare supplement plans in Maryland. It can also be used with Maryland Medicare Advantage plans, but only if the Part C plan does not include Part D.
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 Choice prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Baltimore, Columbia, College Park, Frederick, Rockville, Gaithersburg, Bowie, Hagerstown, Annapolis, Salisbury, Laurel, Bethesda, and all other towns and cities in Maryland.