Most states offer 30 or more Medicare Part D plans. Sometimes it helps to reduce the number of plans that you want to compare. This section explains the search and sort options in PDP-Compare. The Search Criteria are divided into three areas:
Those applying to the plan independent of the plan year
Criteria to be used against the 2014 plans
Criteria to be used against the 2015 plans
Criteria that are used independent of the plan year include:
State - this is a required field. You must select a state.
Plan Family - If you are only interested in certain plans, ex: AARP, then just select the family of plans from the drop-down list.
Other Options - click the checkbox to show only those plans that will be discontinued in 2015.
Sort Results by - Premiums, Plan name, Plan rating, Popularity (Enrollment)
Criteria that apply to a particular plan year must be entered in the appropriate column for the year (2014 or 2015) the search criteria include:
Maximum Premium - Which plans under $25 in 2014 are still under $25 in 2015? - enter 25 in the 2014 column and 25 in the 2015 column
(Answer: in California, only one of the plans that was under $25 in 2014 is still under $25 in 2015. Remove the $25 from the 2014 column to see that an additional nine plans will be under $25 in CA for 2015.
Maximum Deductible - is used just as maximum premium is above.
Type of Gap Coverage - is used just as maximum premium is above, except you select an option in the appropriate column 2014 or 2015 fields.
Full Low-Income Subsidy? - Choose one of the three options: Yes, show only plans that qualify, No, I receive no or only partial extra help,
or Only show Plans that DO NOT qualify for $0 Premium. This option is used if you would like to see only plans which changed their qualification status.
Example: select Yes... in the 2014 column and Only show Plans that DO NOT qualify ... in the 2015 column. You will see that in California, three plans
no longer qualify for the LIS $0 Premium status. Switch the 2014 and 2015 criteria to see that one new plan qualifies in 2015 that did not qualify in 2014.
In this example our New York beneficiary wants to see what changes they can expect in their current plan. We have selected New York as our state. Note that State is the only field that must be entered prior to a search. Since the beneficiary is only interested in Humana Plans, we can narrow down the comparison by selecting Humana in the Plan Family field. We have left the Full Low-Income Subsidy (LIS) field set to No... so that we will see plans which qualify and also those that do not qualify. Then click on "Click to Compare Annual Plan Changes"
The comparison of the three Humana plans is shown for both 2014 and 2015. Our beneficiary can quickly see that the 2014 Humana Walmart Rx and Preferred plans will remain fairly consistent for 2015 except for the increase in plan premiums. The Humana Enhanced will see changes in copayments for Tiers 1 through 3 and Tier 4 cost-sharing will change from a $92.00 copayment to 44% co-insurance.
This California beneficiary wants to know which plans will no longer be offered in 2015. They enter California in the State field
(a required field) and click the checkbox next to Only Show Plans that will be Discontinued in 2015.
They can leave the rest of the search fields empty and then click on Click to Compare Annual Plan Changes.
Our beneficiary can quickly see details of the seven (7) plans that will no longer be offered in California for 2015.
They can also see that members of the AARP MedicareRx Enhanced, Cigna-HealthSpring Rx, First Health Part D Premier Plus and Essentails plans,
SilverScript Choice, and SmartD Rx Plus plans will be automatically re-assigned to other plans unless they choose a new plan for themselves
(details can be found in the Annual Notice of Change sent directly to members by the carrier).
Our California beneficiary can change the additional information field to "Members in this State" to see how many people in California
are currently enrolled in plans that will be discontinued in 2015.
Example 3: Change in Plan Coverage from 2013 to 2014
In this example our North Carolina beneficiary wants to see what changes they can expect in their current plan. We have selected North Carolina as our state. Note that state is the only field that must be entered prior to a search. Since the beneficiary is only interested in SilverScript plans, we can narrow down the comparison by selecting SilverScript in the Plan Family field. We have left all other criteria fields empty. Then click on "Click to Compare Annual Plan Changes"
The comparison of the two SilverScript plans is shown for both 2014 and 2015. Our beneficiary can see that if the stay with their 2014 SilverScript Basic plan for 2015, their plan will now be called SilverScript Choice plan and they will have a $0 deductible. Their premium will be about $5 lower and their cost-sharing will be higher.
Example 4: Advanced Search - Comparing Plans from Different Companies.
Our Arizona beneficiary wants to find a medium priced Medicare Part D plan and wishes to compare plans across different companies. Since there are 38 rows in the Arizona comparison, this list could be a bit cumbersome. Our beneficiary does not want to spend more than $35 per month and does not want to pay a deductible.
This type of search is done by first selecting the State Arizona, and then entering our value 35 in the Maximum Premium field in the 2015 column and 0 in the Maximum Deductible field in the 2015 column. Since we want a medium priced plan and have entered our max, lets let the low priced plan fall to the bottom of the list by selecting 2015 Premium Highest to Lowest in the Sort Results by field. Then click on "Click to Compare Annual Plan Changes"
Our comparison is reduced to only two plans rather than 38.
We can quickly compare the CMS Quality Rating, Premiums, Copays and Coinsurance, and even Plan Popularity across these plans. We can even see the individual plan changes from 2014 to 2015.
Example 5: Advanced Search - Premium increases in California
In this example our California beneficiary wants to see the changes in the most inexpensive Medicare Part D plans. We enter California in the State field, 35 in the 2014 Maximum Premium field, 310 in the 2014 Maximum Deductible field (or leave it blank since $310 is the 2014 maximum deductible. We entered 40 in the 2015 Maximum Premium field, 320 in the 2015 Maximum Deductible field (or leave it blank since $320 is the 2015 maximum deductible. We changed the Sort Results by field to 2015 Premium Highest to Lowest.
Our comparison shows 11 plans that meet our search criteria. Only two plans lowered their premiums, one will be discontinued, and the remaining eight will raise their premiums. Three of the plans no longer qualify for the LIS $0 premium. One plan continues to be sanctioned by CMS and cannot accept new enrollments. The co-payments/co-insurance for all plans can quickly be compared to determine which plan best matches the prescription purchase patterns for the beneficiary.
Below is a key or legend for the PDP-Compare Comparison Chart. The same key is shown just after the PDP-Compare Chart once you click on the Search button.
Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)
CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.
This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.
Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.
This category includes measures of how drug plans rate on the following areas:
Time on Hold When Customer and Pharmacist Calls Drug Plan.
Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.
Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.
This category includes measures of how drug plans rate on the following areas:
Drug Plan Provides Information or Help When Members Need It.
Members’ Overall Rating of Drug Plan.
Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.
RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.
This category includes measures of how drug plans rate on the following areas:
Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.
Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
Deductible: This is the $ deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)
Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $ in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year , ALL formulary generics will have at least a 0% discount and ALL brand drugs will have at least a 0% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
No Gap Coverage: you must pay the $;
Yes: This plan offers some level of gap coverage.
$0 Premium with Full LIS - Does the plan Qualify for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
Plan ID: This is the unique id for this particular plan.
Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. Plans can form their own tiers, so you should contact the plan or reference it’s summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)
Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)
Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
Members in This State (updated: figures) - This is the total number of members in this plan for this PDP CMS Region. For regions that contain more than one state, this is the total for all of those states combined. If the CMS Region contains more than one state, the actual state enrollment is shown, along with the CMS region and national enrollment figures on the plan details page. you can access the plan details by clicking the plan name, orange enroll options button, or the plan details icon.
Members Nation Wide (updated: figures) - This is the total number of member for this plan in all CMS Regions (States) combined.
Initial Coverage Limit (ICL) - The initial coverage limit phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for is $ and increases each year.
National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.
(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)
Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.
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The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.