Medicare & Other Benefits

Interpreting the plan summaries

When you click on a plan name, several important items can be found:

Top Right Hand Corner

• Contains your Zip Code, Drug List Number, and Password Date.
• These items are useful if you go to Medicare.gov. 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, you cannot tell why a particular plan received a higher or lower rating. You can be confident in all the plans since they have been approved by Medicare.

Under the Plan Name are the Fixed Costs of the plan

• The Monthly Plan Premium and any Annual Drug Deductibles are listed.
  • Monthly Plan Premium – the amount you will pay each month for the plan whether you use the plan or not.
  • 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 will not 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. You should take into consideration the total annual out-of-pocket cost for each pharmacy that you selected and mail order (if available). 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 show your out-of-pocket expense for each drug:
• If the plan has a Deductible, the next column shows you paying the full amount of the drug until you reach the deductible amount:
  • Initial Coverage Level – shows what you pay when the plan is in full effect
  • 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.
  • 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
    • 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