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Medicare prescription drug plans (PDP) in Pennsylvania provide quality coverage for Seniors. The different types of drugs are preferred generic (Tier 1), generic (Tier 2), preferred brand (Tier 3), non-preferred drug (Tier 4), and specialty (Tier 5). Prescription benefits are available through Medicare Advantage plans, or separate Part D coverage. All plans publish their specific covered drugs (formulary), which should be reviewed before enrollment, which is voluntary. Available pharmacies should also be considered.

After you compare 2019 options and choose the specific plan you prefer, enrollment can be easily completed online, by phone, or through the mail. You will be required to provide your ID number (found on your Medicare Card), and the dates that your Parts A and B coverage began. If you have existing prescription drug benefits, you may not want to enroll in an Advantage plan. AARP, Aetna, and many carriers offer consumers multiple choices.

 

Penalty, Out-Of-Pocket Expenses, And Star Ratings

If you do not enroll during the time you initially become eligible, a late enrollment fee may be applied. The extra premium is added to your regular payment if you have a 63 day lapse in benefits. The penalty applies if you go without a Part D plan, a Part C plan, or another plan that provides coverage, or a "credible" plan. The penalty (national base beneficiary premium) is $33.19 times the number of uncovered months.

The penalty can increase each year. You may request a reconsideration if you don't agree with the penalty. A completed form is required to be received within 60 days from when you received official notification. Written proof should be submitted with your form.

The program was created by Federal Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003. The MMA also created subsidies and tax breaks to help lower-income households obtain benefits.

Your out-of-pocket costs consist of the premium you pay, the annual deductible (if applicable), coinsurance, copayments, coverage gaps, and late enrollment fees (if deadline is missed). Using drugs that are on your plan formulary list will reduce your costs. Utilizing pharmacies inside your carrier's network will also save money. Households with limited income may be eligible for financial assistance.

Extra Help And Star Rating

"Extra Help" is offered if the household income is $18,735 (one person), or $25,365 (couple). The amount of resources may also impact eligibility. $14,390 in resources is allowed for a single person, and $28,720 is allowed for a married couple. Resources include funds in savings money market, and checking accounts, stocks, and bonds. Vehicles, homes, furniture, household items, and up to $1,500 for burial expenses are not included.

Medicare utilizes a star rating system to measure the performance of Part D plans. The highest rating is 5 stars, and the lowest possible rating is 1 star. Ratings are a valuable tool that helps consumers rate plans. Every year, ratings and reviews are updated to reflect current changes. The four rating categories are: Drug pricing and patient safety, member experience with the plan, member complaints, service problems and issues, and deciding to leave the plan, and customer service and relations.

If other benefits are in effect, it is important to understand the impact it will have on any new coverage. For example, benefits through TRICARE, your employer, the VA, or a special agreement with a drug manufacturer may be impacted by your choice of coverage. Also, if you receive your drugs through Medical Assistance, you must enroll in a Part D plan.

 

The Donut Hole

Once $3,820 has been spent on drugs and the policy deductible, you are in the coverage gap (Donut Hole). Temporarily, there may be specified limits and out-of-pocket expenses on benefits. Brand name prescription drugs will be capped at 25% when you purchase them at a pharmacy or utilize mail-order options. However, 95% of the price and 70% of the company discount count towards the $3,820.

63% of the cost of generic drugs is covered by Medicare, leaving 37% of the cost for consumers. By 2020, the percentage reduces to 20%. However, only the amount paid is credited towards the "Donut Hole." Coinsurance, copays, the deductible, and brand-name drug discounts count towards the coverage gap. Your cost of uncovered drugs, the plan premium and pharmacy dispensing fee are not counted.

 

Pennsylvania Prescription Assistance Programs For Older Adults

PACE - Applicants must be 65 years old or older, and lived in the Keystone State for at least 90 days prior to the application date. You also can not be receiving Medicaid prescription benefits. If single, income must be $14,500 or less. If married, household income must be $17,700 or less.

PACENET - Requirements are the same as PACE, except single income can be between $14,500 and $27,500, and married income can be between $17,700 and $35,500.

 

Shown below are all available 2019 Pa Medicare prescription drug plans offered. Premiums, deductibles, and copays are subject to change each year. CMS plan ratings apply to all plans. Five ratings are available. 5 stars (excellent), 4 stars (very good), 3 stars (good), 2 stars (fair) and 1 star (poor). A customer-service rating is also provided. "Member plan experience" indicates how available drugs are to covered members. New plans may not have a rating yet. These are "stand-alone" plans and are not designed to replace Parts A and B.

 

Senior Medicare Drug plans in Pennsylvania provide prescription benefits to Keystone State consumers. Compare all plans from Major companies and enroll online.

 

EnvisionRxPlus - $14.50 monthly rate with $325 deductible (Tier 1 not subject to deductible). 2,963 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $6 (Tier 2), $35 (Tier 3), 35% (Tier 4), and 26% (Tier 5). Preferred 90-day drug copays are $2 (Tier 1), $18 (Tier 2), $105 (Tier 3), 35% (Tier 4), and n/a (Tier 5). 2.0-Star CMS Overall Star Rating. Plan ID is S7694-006-0. Low-income subsidy is available. 83,178 Pa residents are enrolled in this plan. 590,748 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Aetna MedicareRx Select - $17.20 monthly rate with $380 deductible (Tiers 1 and 2 not subject to deductible). 3,737 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $6 (Tier 2), $141 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5810-280-0. 23,175 Pa residents are enrolled in this plan. 560,402 persons in the entire US are enrolled in this plan. Some additional gap coverage.

 

Aetna MedicareRx Saver - $34.90 monthly rate with $290 deductible (Tiers 1 and 2 not subject to deductible). 3,283 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $2 (Tier 2), $30 (Tier 3), 35% (Tier 4), and 27% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $6 (Tier 2), $90 (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5810-040-0. Low-income subsidy is available. 25,714 Pa residents are enrolled in this plan. 1,225,142 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Humana Walmart Rx Plan - $28.50 monthly rate with $415 deductible (Tier 1 not subject to deductible). 3,055 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $4 (Tier 2), 20% (Tier 3), 35% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $12 (Tier 2), 20% (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-152-0. 75,848 Pa residents are enrolled in this plan. 2,054,294 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Humana Preferred Rx Plan - $35.50 monthly rate with $415 deductible. 2,968 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $1 (Tier 2), 25% (Tier 3), 3585% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $3 (Tier 2), 25% (Tier 3), 38% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-140-0. Low-income subsidy is available. 40,935 Pa residents are enrolled in this plan. 1,645,559 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Humana Enhanced - $73.70 monthly rate with $0 deductible. 3,174 formulary drugs available. Preferred 30-day drug copays are $5 (Tier 1), $10 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $15 (Tier 1), $30 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-005-0. 20,338 Pa residents are enrolled in this plan. 701,031 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Express Scripts Medicare Saver - $25.40 monthly rate with $415 deductible (Tiers 1 and 2 not subject to deductible). 2,806 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $4 (Tier 2), 18% (Tier 3), 33% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $12 (Tier 2), 18% (Tier 3), n/a (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5660-222-0. 8,025 Pa residents are enrolled in this plan. 198,739 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

Express Scripts Medicare Value - $36.20 monthly rate with $415 deductible. 2,931 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $3 (Tier 2), $26 (Tier 3), 35% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $9 (Tier 2), $78 (Tier 3), n/a (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5660-108-0. Low-income subsidy is available. 40,002 Pa residents are enrolled in this plan. 492,540 persons in the entire US are enrolled in this plan. No additional gap coverage. 

 

Express Scripts Medicare Choice - $100 monthly rate with $350 deductible (Tiers 1 and 2 not subject to deductible). 3,268 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $7 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 26% (Tier 5). Preferred 90-day drug copays are $6 (Tier 1), $21 (Tier 2), $126 (Tier 3), n/a (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5660-176-0. 1,198 Pa residents are enrolled in this plan. 59,626 persons in the entire US are enrolled in this plan. Some additional gap coverage.  

 

AARP MedicareRx Walgreens - $28.00 monthly rate with $415 deductible (Tier 1 not subject to deductible). 2,884 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $30 (Tier 3), 32% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), $90 (Tier 3), 32% (Tier 4), and 25% (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5921-388-0. 22,279 Pa residents are enrolled in this plan. 700,007 persons in the entire US are enrolled in this plan. No additional gap coverage.       

 

AARP MedicareRx Saver Plus - $35.80 monthly rate with $415 deductible. 2,954 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), $25 (Tier 3), 33% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), $75 (Tier 3), 33% (Tier 4), and 25% (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5921-351-0. Low-income subsidy is available. 45,849 Pa residents are enrolled in this plan. 1,319,149 persons in the entire US are enrolled in this plan. No additional gap coverage.            

 

AARP MedicareRx Preferred - $75.70 monthly rate with $0 deductible. 3,367 formulary drugs available. Preferred 30-day drug copays are $5 (Tier 1), $10 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $15 (Tier 1), $30 (Tier 2), $120 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5820-005-0. 96,818 Pa residents are enrolled in this plan. 2,328,777 persons in the entire US are enrolled in this plan. No additional gap coverage.            

 

Basic Blue Rx Value - $21.80 monthly rate with $415 deductible (Tier 1 not subject to deductible). 3,006 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $1 (Tier 2), 15% (Tier 3), 35% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $3 (Tier 2), 15% (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S6986-010-0. Low-income subsidy is available. 1,179 Pa residents are enrolled in this plan. 3,029 persons in the entire US are enrolled in this plan. No additional gap coverage.            

 

Blue Rx PDP Plus - $84.70 monthly rate with $415 deductible. 4,160 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $7 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $21 (Tier 2), 20% (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5593-002-0. 9,258 Pa residents are enrolled in this plan. 10,400 persons in the entire US are enrolled in this plan. No additional gap coverage. 

 

Blue Rx PDP Complete - $156.00 monthly rate with $0 deductible. 4,160 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 35% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5593-003-0. 1,179 Pa residents are enrolled in this plan. 3,029 persons in the entire US are enrolled in this plan. Some additional gap coverage.       

 

SilverScript Choice - $32.50 monthly rate with $0 deductible. 2,995 formulary drugs available. Preferred 30-day drug copays are $3 (Tier 1), $14 (Tier 2), $43 (Tier 3), 43% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $9 (Tier 1), $42 (Tier 2), $129 (Tier 3), 43% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-012-0. Low-income subsidy is available. 189,988 Pa residents are enrolled in this plan. 4,579,835 persons in the entire US are enrolled in this plan. No additional gap coverage.          

 

SilverScript Plus - $59.10 monthly rate with $0 deductible. 3,011 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), $35 (Tier 3), 40% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), $105 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-013-0. 7,317 Pa residents are enrolled in this plan. 227,974 persons in the entire US are enrolled in this plan. Some additional gap coverage.  

 

SilverScript Allure - $80.00 monthly rate with $0 deductible. 3,058 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), 20% (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-148. 808 Pa residents are enrolled in this plan. 21,522 persons in the entire US are enrolled in this plan. No additional gap coverage.              

 

Cigna-HealthSpring Rx Secure - $34.40 monthly rate with $415 deductible. 3,195 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $3 (Tier 2), $30 (Tier 3), 36% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $9 (Tier 2), $90 (Tier 3), 36% (Tier 4), and n/a (Tier 5). 2.0-Star CMS Overall Star Rating. Plan ID is S5617-215-0. 27,042 Pa residents are enrolled in this plan. 534,813 persons in the entire US are enrolled in this plan. No additional gap coverage.     

 

Cigna-HealthSpring Rx Secure Extra - $55.40 monthly rate with $100 deductible. 3,317 formulary drugs available. Preferred 30-day drug copays are $4 (Tier 1), $10 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 31% (Tier 5). Preferred 90-day drug copays are $12 (Tier 1), $30 (Tier 2), $126 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 2.0-Star CMS Overall Star Rating. Plan ID is S5617-251-0. 5,082 Pa residents are enrolled in this plan. 164,391 persons in the entire US are enrolled in this plan. No additional gap coverage.     

 

WellCare Classic - $34.80 monthly rate with $415 deductible (Tier 1 not subject to deductible). 2,989 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $2 (Tier 2), $37 (Tier 3), 42% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $6 (Tier 2), $111 (Tier 3), 42% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S4802-080-0. Low-income subsidy is available. 64,026 Pa residents are enrolled in this plan. 975,423 persons in the entire US are enrolled in this plan. No additional gap coverage.  

 

WellCare Extra - $72.60 monthly rate with $0 deductible. 3,327 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 46% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S4802-103-0. 1,662 Pa residents are enrolled in this plan. 57,961 persons in the entire US are enrolled in this plan. No additional gap coverage.

 

WellCare Value Script - $15.50 monthly rate with $415 deductible (Tier 1 not subject to deductible). 3,327 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 46% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S4802-141-0. 16,575 Pa residents are enrolled in this plan. 455,504 persons in the entire US are enrolled in this plan. No additional gap coverage.  

 

SecureRx - Option 3 - $86.00 monthly rate with $15 deductible. 3,078 formulary drugs available. Preferred 30-day drug copays are $10 (Tier 1), $15 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 32% (Tier 5). Preferred 90-day drug copays are $30 (Tier 1), $45 (Tier 2), $126 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-001-0. 1,834 Pa residents are enrolled in this plan. 2,123 persons in the entire US are enrolled in this plan. No additional gap coverage.    

 

SecureRx - Option 1 - $108.00 monthly rate with $0 deductible. 4,086 formulary drugs available. Preferred 30-day drug copays are $4 (Tier 1), $15 (Tier 2), $38 (Tier 3), $89 (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $12 (Tier 1), $45 (Tier 2), $114 (Tier 3), $267 (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-003-0. Pa residents are enrolled in this plan. 1,313 Pa residents are enrolled in this plan. 1,553 persons in the entire US are enrolled in this plan. No additional gap coverage.