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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. A unique ID is provided for each plan.

After you compare 2022 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. MA-PD (Medicare Advantage plans with drug benefits) are also offered.

25 PDP plans are offered including 5 plans with a $0 deductible.  15 plans are  enhanced (EA) and  10 plans are basic (DS, AE, and BA). The least expensive $0 deductible plan costs $69.00 per month. The range of monthly rates is $7.20 (least expensive) – $178.30 (most expensive). Five plans offer premiums that reduced this year and the average monthly rate of all plans is $52.86. Also, all Aetna  plans are under WellCare.

The five $0 deductible plans are Wellcare Medicare Rx Value Plus, SilverScript Plus, SecureRx – Option 1, AARP Medicare Rx Preferred, and Blue Rx PDP Complete. Five plans lowered their rates, while nineteen plans increased rates. The average monthly increase was $5.79.

 

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 $32.74 times the number of full uncovered months. Members are always notified if they owe a penalty. Reconsideration of decisions are completed within 90 days.

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. Under the program, the SSA determines if an individual that is eligible for Part D benefits qualifies for a subsidy with income up to 15% of the Federal Poverty Level guidelines. Information may also be provided by the Office of Child Support Enforcement or the Department of Veterans Affairs.

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.

The deductible is $480 (up from $445 last year) and the total covered Part D drug out-of-pocket spending (including the coverage gap) is $10,012.50 (Total covered Part D spending for out-of-pocket threshold for beneficiaries). At this point, catastrophic coverage begins.

 

Extra Help And Star Rating

“Extra Help” is offered if the household income is $19,140 (one person), or $25,860 (couple). The amount of resources may also impact eligibility. $14,610 in resources is allowed for a single person, and $29,160 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.

Documents can be sent directly to your plan. Examples include a green or yellow enrollment notice, an orange notice indicating the premium will change the following year, a purple notice that informs you that you have qualified, and a “Notice Of Award” from Social Security. Proof of Medicaid is provided with a state document, Medicaid card, Medicaid systems screen shot, and copy of state electronic file.

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. Other insurance plans that work with Part D benefits include food stamps, Marketplace plans, COBRA, Medicaid, Long-term care facility, HUD assistance, Group and union benefits, and SS income benefits.

 

The Donut Hole

Once $4,430 (increased from $4,130) 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 $4,430. The out-of-pocket threshold is $7,050, an increase of $500 from last year. Total estimated covered Part D drug out-of-pocket spending is $10,690.12.

 

80% of the cost of generic drugs is covered by Medicare, leaving 20% of the cost for consumers. 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.

 

LIS Benchmark Premium

This premium is the maximum Medicare Part D premium that is paid by CMS for applicants that qualify for the “Extra Help” program or LIS (low-income subsidy). In Pennsylvania, if the premium is higher than $40.74 per month, the beneficiary pays the difference in premiums.

Shown below are all available 2022 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.

Humana Walmart Value Rx Plan – $22.70 monthly rate with $480 deductible (Tiers 1 and 2 not subject to deductible). 3,184 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $4 (Tier 2), 16% (Tier 3), 42% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), 16% (Tier 3), 42% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $12 (Tier 2), 16% (Tier 3), 42% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S5884-185. 41,749 Pa residents are enrolled in this plan. 1,130,196 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. No additional gap coverage. Plan Formulary drugs include 156 in Tier 1, 686 in Tier 2, and 716 in Tier 3.

Humana Basic Rx Plan – $38.30 monthly rate with $480 deductible. 3,060 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $1 (Tier 2), 19% (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $3 (Tier 2), 19% (Tier 3), 40% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), 15% (Tier 3), 30% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S5884-104. 34,855 Pa residents are enrolled in this plan. 1,286,538 persons in the entire US are enrolled in this plan. $0 premium is available if full LIS benefits. No additional gap coverage. Plan Formulary drugs include 142 in Tier 1, 637 in Tier 2, and 730 in Tier 3.

Humana Premier Rx – $81.30 monthly rate with $480 deductible. 3,242 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 49% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $12 (Tier 2), $135 (Tier 3), 49% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), $125 (Tier 3), 49% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S5884-152. 34,994 Pa residents are enrolled in this plan. 1,083,163 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. No additional gap coverage. Plan Formulary drugs include 259 in Tier 1, 587 in Tier 2, and 738 in Tier 3. Plan ID Number S5884-152.

Clear Spring Health Premier Rx – $18.20 monthly rate with $480 deductible. 3,150 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), $42 (Tier 3), 45% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), $126 (Tier 3), 45% (Tier 4), and 25% (Tier 5).  Preferred 90-day mail-order drug copays are $3 (Tier 1), $15 (Tier 2), $126 (Tier 3), 45% (Tier 4), and 25% (Tier 5). 2.0-Star CMS Overall Star Rating. Plan ID is S6946-032. 9,232 Pa residents are enrolled in this plan. 201,342 persons in the entire US are enrolled in this plan.  $0 premium not available if full LIS benefits. No additional gap coverage. Plan Formulary drugs include 212 in Tier 1, 245 in Tier 2, and 838 in Tier 3. Plan ID Number S6946-032.

Clear Spring Health Value Rx – $32.80 monthly rate with $480 deductible. 3,138 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $3 (Tier 2), $42 (Tier 3), 39% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $9 (Tier 2), $126 (Tier 3), 39% (Tier 4), and 25% (Tier 5). Preferred 90-day mail-order drug copays are $3 (Tier 1), $9 (Tier 2), $126 (Tier 3), 39% (Tier 4), and 25% (Tier 5). 2.0-Star CMS Overall Star Rating. Plan ID is S6946-003. 4,780 Pa residents are enrolled in this plan. 90,432 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. No additional gap coverage. Plan Formulary drugs include 209 in Tier 1, 597 in Tier 2, and 497 in Tier 3. Plan ID Number S946-003.

AARP MedicareRx Walgreens – $29.30 monthly rate with $310 deductible (Tier 1 not subject to deductible). 3,150 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $10 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 27% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $30 (Tier 2), $120 (Tier 3), 40% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $30 (Tier 2), $120 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S5921-388. 19,512 Pa residents are enrolled in this plan. 687,519 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Plan Formulary drugs include 54 in Tier 1, 517 in Tier 2, and 1,032 in Tier 3.

AARP MedicareRx Saver Plus – $38.00 monthly rate with $480 deductible. 3,153 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), $38 (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), $115 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S5921-351. 42,070 Pa residents are enrolled in this plan. 878,540 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Plan Formulary drugs include 89 in Tier 1, 823 in Tier 2, and 705 in Tier 3.

AARP MedicareRx Preferred – $101.00 monthly rate with $0 deductible. 3,567 formulary drugs available. Preferred 30-day drug copays are $5 (Tier 1), $10 (Tier 2), $45 (Tier 3), 40% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $15 (Tier 1), $30 (Tier 2), $135 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5820-005. 70,624 Pa residents are enrolled in this plan. 1,643,903 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Plan Formulary drugs include 155 in Tier 1, 719 in Tier 2, and 968 in Tier 3.

Blue Rx PDP Plus – $109.10 monthly rate with $480 deductible. 4,151 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). 4.0-Star CMS Overall Star Rating. Plan ID is S5593-002. 11,767 Pa residents are enrolled in this plan. 13,208 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 529 in Tier 1, 1,379 in Tier 2, and 601 in Tier 3.

Blue Rx PDP Complete – $178.30 monthly rate with $0 deductible. 4,183 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). 4.0-Star CMS Overall Star Rating. Plan ID is S5593-003. 6,858 Pa residents are enrolled in this plan. 7,801 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is available. Formulary drugs include 529 in Tier 1, 1,376 in Tier 2, and 606 in Tier 3.

Mutual Of Omaha Rx Premier – $35.90 monthly rate with $480 deductible. 3,018 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $13 (Tier 2), 23% (Tier 3), 42% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $39 (Tier 2), 23% (Tier 3), n/a (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7126-075.  4,233 Pa residents are enrolled in this plan. 98,661 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is not available. Formulary drugs include 137 in Tier 1, 605 in Tier 2, and 714 in Tier 3.

Mutual Of Omaha Rx Plus – $80.30 monthly rate with $480 deductible. 2,970 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $3 (Tier 2), 18% (Tier 3), 47% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $9 (Tier 2), 18% (Tier 3), n/a (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7126-005. 590 Pa residents are enrolled in this plan. 19,079 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is not available. Formulary drugs include 137 in Tier 1, 607 in Tier 2, and 647 in Tier 3.

SilverScript Choice – $33.30 monthly rate with $480 deductible. 3,108 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), 17% (Tier 3), 41% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), 17% (Tier 3), 41% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-012. Low-income subsidy is available. 129,467 Pa residents are enrolled in this plan. 3,214,280 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 97 in Tier 1, 595 in Tier 2, and 828 in Tier 3.

SilverScript Plus – $73.30 monthly rate with $0 deductible. 3,278 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $0 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-013. Low-income subsidy is not available. 7,842 Pa residents are enrolled in this plan. 235,531 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage available. Formulary drugs include 195 in Tier 640 in Tier 2, and 808 in Tier 3.

SilverScript SmartRx – $7.20 monthly rate with $480 deductible. 3,601 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $19 (Tier 2), $46 (Tier 3), 49% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $57 (Tier 2), $138 (Tier 3), 49% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-181. Low-income subsidy is not available. 71,504 Pa residents are enrolled in this plan. 1,201,863 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 250 in Tier 1, 615 in Tier 2, and 786 in Tier 3.

Cigna Secure Rx – $36.80 monthly rate with $480 deductible. 3,190 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $2 (Tier 2), $20 (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $6 (Tier 2), $60 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5617-215. 49,708 Pa residents are enrolled in this plan. 868,540 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 83 in Tier 1, 558 in Tier 2, and 678 in Tier 3.

Cigna Secure-Extra Rx – $45.60 monthly rate with $100 deductible. 3,235 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). 3.5-Star CMS Overall Star Rating. Plan ID is S5617-251. 5,082 Pa residents are enrolled in this plan. 156,685 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage available. Formulary drugs include 180 in Tier 1, 671 in Tier 2, and 743 in Tier 3.

Cigna Secure-Essential Rx – $24.00 monthly rate with $445 deductible. 3,109 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $2 (Tier 2), 18% (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $6 (Tier 2), 18% (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5617-285. 6,350 Pa residents are enrolled in this plan. 216,815 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 149 in Tier 1, 696 in Tier 2, and 524 in Tier 3.

WellCare Classic – $35.90 monthly rate with $480 deductible. 3,110 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $6 (Tier 2), $39 (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $8 (Tier 2), $117 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S4802-080. Low-income subsidy is available. 58,399 Pa residents are enrolled in this plan. 1,473,307 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 123 in Tier 1, 461 in Tier 2, and 1,094 in Tier 3.

WellCare Value Script – $12.90 monthly rate with $480 deductible (Tiers 1 and 2 not subject to deductible). 3,450 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 47% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), $126 (Tier 3), 47% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S4802-141. 94,900 Pa residents are enrolled in this plan. 2,110,773 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 347 in Tier 1, 444 in Tier 2, and 1,033 in Tier 3.

WellCare Medicare Rx Value Plus – $69.00 monthly rate with $0 deductible. 3,470 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5768-129. 24,530 Pa residents are enrolled in this plan. 577,317 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 363 in Tier 1, 433 in Tier 2, and 1,048 in Tier 3.

SecureRx – Option 3 – $60.95 monthly rate with $265 deductible. 2,744 formulary drugs available. Preferred 30-day drug copays are $8 (Tier 1), $12 (Tier 2), $40 (Tier 3), 50% (Tier 4), and 28% (Tier 5). Preferred 90-day drug copays are $24 (Tier 1), $36 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-001. 1,519 Pa residents are enrolled in this plan. 1,761 persons in the entire US are enrolled in this plan.  $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 68 in Tier 1, 563 in Tier 2, and 691 in Tier 3.

SecureRx – Option 1 – $107.50 monthly rate with $0 deductible. 3,471 formulary drugs available. Preferred 30-day drug copays are $3 (Tier 1), $10 (Tier 2), $38 (Tier 3), $88 (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $9 (Tier 1), $30 (Tier 2), $114 (Tier 3), $264 (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-003. 1,507 Pa residents are enrolled in this plan. 1,728 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 292 in Tier 1, 832 in Tier 2, and 750 in Tier 3.

Elixir RxPlus – $15.60 monthly rate with $445 deductible. 3,229 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $6 (Tier 2), $43 (Tier 3), 45% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $18 (Tier 2), $129 (Tier 3), 45% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7694-126. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 206 in Tier 1, 625 in Tier 2, and 523 in Tier 3.

Elixir RxSecure – $35.00 monthly rate with $445 deductible. 3,168 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $7 (Tier 2), 15% (Tier 3), 35% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $21 (Tier 2), 15% (Tier 3), 34% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7694-006. 107,164 Pa residents are enrolled in this plan. 844,835 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 206 in Tier 1, 612 in Tier 2, and 501 in Tier 3.

Indy Health EliteRx – $47.10 monthly rate with $0 deductible. 3,578 formulary drugs available. Preferred 30-day drug copays are $3 (Tier 1), $5 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $9 (Tier 1), $15 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Plan ID is S3535-005. 3,685 Pa residents are enrolled in this plan. 14,904 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 353 in Tier 1, 1,333 in Tier 2, and 327 in Tier 3.

Indy Health SaverRx – $34.00 monthly rate with $445 deductible. 3,219 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $30 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Plan ID is S3535-009. 5,208 Pa residents are enrolled in this plan. 13,913 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 353 in Tier 1, 1,251 in Tier 2, and 324 in Tier 3.

Persons with CRDP are helped by the Chronic Renal disease Program and Medicare Part D. From the day of eligibility, 63 days is provided to enroll. Otherwise, a lifetime late enrollment penalty may be imposed. Out-of-pocket costs for medications are reduced, and a confirmation letter will be sent.