Interpreting the plan summaries
When you click on a plan name, several items of important information can be found:
Top Right Hand Corner
· Contains your Zip Code, Drug List Number, and Password Date
· This items are useful if you go to Medicare.gov
· By using these three pieces of information, you can retrieve your drug information
The Plan Name and Plan Code Number are near the Center of the Page
· You will need both the Plan Name and Plan Code Number to enroll in the plan
· Contact Information for the Plan is located to the right of the name
· To Enroll, you will call the Non-Member Phone Number
The Overall Plan Rating is to the right of the phone numbers
· The higher number of stars the better the rating
· However, we do not know why the plan received a higher or lower rating
· One can be confident in all the plans since they have been approved by Medicare
Under the Plan Name is the Fixed Costs of the plan
· The Monthly Plan Premium and any Annual Drug Deductibles are listed
o Monthly Plan Premium – the amount you will pay each month for the plan whether you use the plan or not
o Annual Drug Deductible – the amount you will pay out of pocket before the plan benefits begin. The premium does not count toward the deductible; only the actual cost of the drug(s) counts.
· These costs cannot change during the year
· Each plan will have its own premium and deductible charges
Estimated Annual Drug Costs
· Located under the Fixed Costs
· Your decision making begins here. Select the plan that meets your needs at the lowest annual cost.
· The total annual out-of-pocket cost for each pharmacy that you selected and mail order, if available, is listed
· The cost includes all premiums, deductibles, co-pays, and co-insurance
· By clicking on the pharmacy name, the cost details at that particular pharmacy will appear
Drug Cost and Plan Coverage are listed for each drug
· First column lists the full cost of the drug
· Second column is the refill frequency
· The rest of the columns shows your out-of-pocket expense for each drug:
o If the plan has a Deductible, the next column shows you paying the full amount of the drug until you reach the deductible amount
o Initial Coverage Level – shows what you pay when the plan is in full effect
o Coverage Gap – shows what you pay when you are in the donut hole/coverage gap. This column is included whether you reach the donut hole or not. For a definition of the donut hole, click here.
o Catastrophic Coverage – shows the amount you pay when you have reached the far side of the donut hole.
Estimated Monthly Drug Costs
· A bar graph depicts your monthly cost for that plan
· If there is a deductible, you will notice a decrease in the expenses once the deductible is fully met
· If you reach the donut hole, you will see an increase in the monthly cost in the middle of the year
· If you reach catastrophic coverage, you will see a decrease in the monthly expenses as you leave the coverage gap
Drug Coverage Information
· Each drug is listed along with its Tier (Formulary Status), Prior Authorization, Quantity Limits, and STEP Therapy
· If a drug has a Quantity Limit, click on YES for more details
· Ideally, you want to have all of your medications to be Tier 1 drugs as these are the least expensive drugs
o Each plan determines its own Formulary List, therefore, the same drug can be different tier levels depending upon the plan
Drug List
· The list of the medications that you typed in are listed along with their quantity and frequency
