Stand-Alone Prescription Drug Plans
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1 Landscape of Plan Options in Michigan Stand-Alone Prescription Drug Plans MEDICARE TTY
2 Stand-Alone Prescription Drug Plans Landscape What is the Landscape of Local Plans? The Landscape of Local Plans lists all plans available in your area, providing important information on: Cost (premiums, deductibles and payments) Coverage (important issues around what and how drugs are covered) Convenience (pharmacy and mail-order options) How to read the Stand-Alone Prescription Drug Plans Landscape Stand-alone Prescription Drug Plans let you add drug coverage to the Original Medicare plan and some Medicare Advantage and other Medicare Health Plans. To help you better understand this information, read on for a description of each column in the Landscape. DESCRIPTION Organization Name: The name of the company offering the Medicare drug plan. Some organizations offer more than one Medicare drug plan. Plan Name: The name of the Medicare drug plan. i
3 COST Drug Plan Premium: The total amount you would pay the plan each month for prescription drug coverage. This amount does not include coverage for other health care expenses like going to the doctor or hospital. You are also responsible for your Part B premium and any premiums for Medigap coverage if you have Medigap. Drug Deductible: The amount you pay before the drug plan begins to pay. COVERAGE Offers Variable Copayments (tiers): In plans that offer variable copayments, you will pay a fixed amount for each drug and this fixed amount may be different depending on the type of drug. For example, you may pay a lower copayment for generic medications compared to brand medications because generic medications may be on a lower formulary level (tier) than brand medications. Type of Extra Coverage Offered in the Gap: All plans offer coverage until you hit a limit of $2,250 in total drug costs. And all plans offer coverage when your out-of-pocket costs exceed $3,600. Some plans offer coverage during the gap between $2,250 in total costs and $3,600 in out-of-pocket costs. Generics Only: Plan covers generic drugs in coverage gap. Generics and Brands: Plan covers generic and brand drugs in coverage gap. Number of Top 100 Drugs on Formulary: How many of the most commonly used 100 drugs by people with Medicare the plan covers. CONVENIENCE Mail Order Offered: Whether you can get your drugs in the mail. For more information about Medicare prescription drug coverage, visit on the web. ii
4 Michigan Stand Alone Prescription Drug Plans Organization Name Description Cost Coverage Type of Extra Coverage Offered in the Plan Name Drug Plan Premium Drug Deductible Offers Variable Copayments (Tiers) Gap (G=generics; G/B=generics & brands) Number of Top 100 Drugs on Formulary Convenience Mail Order Offered Aetna Medicare Aetna Medicare Rx Essentials $37.88 $ Aetna Medicare Aetna Medicare Rx Plus $49.50 $0 G 86 Aetna Medicare Aetna Medicare Rx Premier $65.69 $0 G 100 Blue Cross Blue Shield of Michigan Prescription Blue Option 1 $32.58 $ Blue Cross Blue Shield of Michigan Prescription Blue Option 2 $39.50 $0 100 CIGNA HealthCare CIGNATURE Rx Value Plan $36.43 $ CIGNA HealthCare CIGNATURE Rx Plus Plan $41.56 $0 99 CIGNA HealthCare CIGNATURE Rx Complete Plan $49.95 $0 G 99 Coventry AdvantraRx AdvantraRx Value $20.77 $0 78 Coventry AdvantraRx AdvantraRx Premier $31.41 $0 100 Coventry AdvantraRx AdvantraRx Premier Plus $42.40 $0 100 First Health Premier First Health Premier $25.64 $ Humana Inc. Humana PDP Standard S $13.75 $ Humana PDP Enhanced S5884- Humana Inc. 011 $21.58 $0 99 Humana PDP Complete S5884- Humana Inc. 041 $65.15 $0 G/B 99 Medco Health Solutions, Inc. YOURx PLAN $29.27 $ MEMBERHEALTH Community Care Rx BASIC $32.06 $ Plans approved as of: 11/13/05 1 of 3 Formulary data as of : 11/16/05
5 Michigan Stand Alone Prescription Drug Plans Organization Name Description Cost Coverage Type of Extra Coverage Offered in the Plan Name Drug Plan Premium Drug Deductible Offers Variable Copayments (Tiers) Gap (G=generics; G/B=generics & brands) Number of Top 100 Drugs on Formulary Convenience Mail Order Offered MEMBERHEALTH Community Care Rx CHOICE $40.16 $ MEMBERHEALTH Community Care Rx GOLD $44.01 $ PacifiCare Life and Health Insurance PacifiCare Saver Plan $27.56 $0 78 PacifiCare Life and Health Insurance PacifiCare Select Plan $38.20 $0 87 PacifiCare Life and Health Insurance PacifiCare Comprehensive Plan $43.20 $0 G 78 Pennsylvania Life Insurance Prescription Pathway Bronze Plan Reg 13 $30.75 $ Pennsylvania Life Insurance Prescription Pathway Silver Plan Pennsylvania Life Insurance Reg13 $40.11 $ Prescription Pathway Gold Plan Reg 13 $51.38 $0 92 Priority Medicare Rx PriorityMedicareRx $32.26 $0 98 RxAmerica Advantage Star Plan $32.09 $ RxAmerica Advantage Freedom Plan $34.77 $ SilverScript SilverScript $28.53 $ SilverScript SilverScript Plus $56.63 $ Sterling Prescription Drug Plan Sterling Prescription Drug Plan $56.18 $ Unicare MedicareRx Rewards $25.69 $ Unicare MedicareRx Rewards Plus $33.29 $0 92 Unicare MedicareRx Rewards Premier $44.41 $0 G 98 Plans approved as of: 11/13/05 2 of 3 Formulary data as of : 11/16/05
6 Michigan Stand Alone Prescription Drug Plans Organization Name United American Insurance Description Cost Coverage Type of Extra Coverage Offered in the Plan Name Drug Plan Premium Drug Deductible Offers Variable Copayments (Tiers) Gap (G=generics; G/B=generics & brands) Number of Top 100 Drugs on Formulary Convenience Mail Order Offered UA Medicare Part D Prescription Drug Cov $33.98 $0 99 United Healthcare AARP MedicareRx Plan $26.21 $0 100 United Healthcare United Medicare MedAdvance $30.01 $0 100 WellCare WellCare Signature $24.49 $0 88 WellCare WellCare Complete $42.16 $0 85 WellCare WellCare Premier $45.35 $0 85 Plans approved as of: 11/13/05 3 of 3 Formulary data as of : 11/16/05
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