A few notes to help with the understanding of the 2010 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.
Plan Name: This is the official plan name from 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. (updated: November 2008)
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 $310 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 $3610 in drug costs (the Donut Hole). Many provider’s plans cover the costs that fall into this category for an additional premium. In our chart, you will see one of the following:
No Gap Coverage: you must pay the $3610;
Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $3610;
Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3610;
All Generics : All formulary Generics are covered, but you must pay for Brand Drugs up to $3610;
All Generics & Few Brands: One regional plan (Alliance Medicare RX), only available in Michigan covers all Generics and a few (less than 10%) of Brand drugs on the plan’s formulary.
Many Generics & Few Brands: two regional plans, only available in Florida (Quality Rx Plus) and Wisconsin (DeanCare Rx Enhanced) cover many Generics (65%-100% of formulary generics) and a few (less than 10%) of formulary Brands. (Search Tip: If you would like to reduce the plans shown to just plans with a certain type of gap coverage, select this type of coverage in the "Type of Gap Coverage" field.)
$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. For 2009 Medicare Part D plans, the smallest formulary is the Geisinger Gold Rx 1 plan formulary in PA and WV with 1,994 total medications and the largest formulary is the AARP Enhanced and Preferred plans’ formulary (all states) with 5,218 total formulary drugs. 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: September 2009 figures) - This is the total number of members in this plan for this CMS Region. For regions which contain more than one state, this is the total for all of those states combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
Members Nation Wide (updated: September 2009 figures) - This is the total number of member for this plan in all CMS Regions (States) combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
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 2010 is $2830 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.
