Aetna Medicare 2015 Benefits at a Glance Aetna Medicare Rx Saver (PDP) Aetna Medicare Rx Premier (PDP) Arizona, California, Florida, Nevada, South Carolina 58.02.396.1-NPREF Contact us for answers to your questions or to enroll: 1-855-338-7030 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 February 14, and 8 a.m. to 8 p.m., Monday Friday, from February 15 September 30. Or visit: Compare our prescription drug plans in your area 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. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. For a complete description of benefits, exclusions, limitations and conditions of coverage, refer to the Evidence of Coverage. Y0001_4030_3553_FINAL_2 Accepted 8/2014
Aetna Medicare Rx (PDP) Aetna Medicare Rx Saver (PDP) Prescription drug coverage Monthly plan premium $17.60 - $25.40* Annual drug deductible Tier 1 $275-$310 Tiers 2-5 Retail or mail-order prescription drug coverage Amount you pay for covered prescriptions until costs for you and the plan reach $2,960 (initial coverage limit) One-month supply from a retail or mail-order network pharmacy* Tier 1 Preferred generic Tier 2 Non-preferred generic Tier 3 Preferred brand Tier 4 Non-preferred brand Tier 5 Specialty copay $7-$8 copay $35-$41 copay 34%-39% coinsurance 25%-26% coinsurance Amount you pay for covered prescriptions in the coverage gap (after your initial coverage limit and until your true out-of-pocket costs reach $4,700) One-month supply from a retail or mail-order network pharmacy You will pay 45% on brand name drugs and only 65% of the costs of generic drugs. Amount you pay for covered prescriptions after your true out-of-pocket costs reach $4,700 (catastrophic coverage) Retail or prescription mail order Pharmacy network Wide variety of chain and independent pharmacies in all our networks The greater of $2.65 copay for generic drugs (including brand drugs treated as generic), $6.60 copay for all other covered drugs OR 5% coinsurance Saver Formulary name Broad list of generic and brand drugs covered by your plan Saver Formulary 1 * Monthly plan premiums and cost sharing vary by region. Please see the 2015 Aetna Medicare Rx (PDP) plan offerings section of this document for exact costs for your area.
Aetna Medicare Rx Premier (PDP) $118.20 - $145.70* Preferred pharmacies Standard pharmacies copay $4 copay $3 copay $7 copay $42-$45 copay $42-$45 copay 50% coinsurance 50% coinsurance 33% coinsurance 33% coinsurance Continued plan coverage for Tier 1 drugs and partial coverage for Tier 3 and Tier 4 drugs. You will pay 45% on brand drugs and only 65% of the costs of generic drugs on non-supplemental generic gap coverage. The greater of $2.65 copay for generic drugs (including brand drugs treated as generic), $6.60 copay for all other covered drugs OR 5% coinsurance Premier preferred Premier Formulary 2
Here's what you get with the Aetna Medicare Rx Saver (PDP) Convenience - Fill your prescriptions at any of our 20,000 pharmacies nationwide. Many offer 24-hour or extended-hours service and drive-through pharmacies. - Mail services with Aetna Rx Home Delivery and Aetna Specialty Pharmacy deliver prescriptions to your door. Call 1-866-782-2779 (TTY: 1-877-833-2779), Monday-Friday, 8 a.m. to 7 p.m. or see your Evidence of Coverage for details. Added cost savings - Enjoy a low monthly plan premium. - Tier 1 preferred generic drugs cover commonly used high blood pressure, high cholesterol and diabetes generic drugs at copay ** at a preferred pharmacy. - Save even more with low $7-$8 copays** on nearly 1,000 Tier 2 generic drugs. Aetna Medicare Rx Premier (PDP) delivers more robust coverage deductible first dollar coverage on all formulary generic and brand-name drugs Tier 1 preferred generic drugs cover commonly used high blood pressure, high cholesterol and diabetes generic drugs at cost sharing at a preferred pharmacy Coverage of over 1,100 Tier 2 generic drugs at a $3 copay when using a preferred pharmacy All Tier 1 drugs and partial Tier 3 and Tier 4 drugs are covered in the coverage gap at regular plan cost sharing Commonly used brand name drugs covered by Medicare Part D 30,000 preferred pharmacies, which may lead to even greater savings on your prescription drugs Access to more than 65,000 pharmacies nationwide Convenient mail services with Aetna Rx Home Delivery and Aetna Specialty Pharmacy deliver prescriptions to your door. To learn more, call 1-866-782-2779 (TTY: 1-877-833-2779), Monday-Friday, 8 a.m. to 7 p.m. or see your Evidence of Coverage for details. ** Copays apply after fulfilling your deductible.
You'll save money when you use our network pharmacies You ll always pay less when you fill your prescription at one of our network pharmacies. But you may save even more when you fill it at a preferred pharmacy. To be part of our pharmacy network, pharmacies must meet our strict credentialing and discount standards. But some pharmacies offer us even bigger discounts. These pharmacies make up our preferred pharmacy network. And we pass their discounts on to you in the form of lower cost-sharing. With our prescription drug plans (PDP), you ll see tiers with two copays listed. The lower copay is what you ll pay for the same drug at a preferred pharmacy. And where the coinsurance is the same at a preferred and standard pharmacy, you still can save. That's because the percentage you pay at a preferred pharmacy for the same drug may be at a lower discounted price. Finding a preferred pharmacy is easy. Just call us toll-free at 1-855-338-7030 (TTY: 711). Or visit:. Find the drugs you need in your plan s formulary A formulary is a list of drugs your plan covers. Our formularies include many of the most commonly prescribed generic and brand-name drugs. You'll find generic drugs at the lowest cost in Tier 1. Some costlier generic drugs appear along with brand-name drugs in higher tiers. There may be lower-cost generic drug options on lower drug tiers. Choosing one of these less-expensive drugs helps you save more at the pharmacy. You ll get extra features and benefits when you choose an Aetna Medicare Rx prescription drug plan Two national prescription drug plans we have you covered with an option designed with you in mind Online tools help you manage your plan, your health and your budget. Visit /member. Access to Aetna Navigator, our secure member website, where you can get details on your specific plan benefits, look up the status of a claim and check the price of a prescription drug Learn more about plan benefits, costs and covered drugs Call to learn more about Aetna Medicare prescription drug plans or to schedule an appointment with a sales representative. Call us toll-free at 1-855-338-7030 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 February 14, and 8 a.m. to 8 p.m., Monday Friday, from February 15 September 30. Or visit:.
2015 Aetna Medicare Rx (PDP) plan offerings Aetna Medicare Rx Saver (PDP) Initial coverage 1, 2 Monthly Annual Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Coverage STATE(S) Premium Deductible 4 Gap SC $25.40 $295 $7 $41 39% 25% Catastrophic Coverage FL AZ $17.60 $22.60 NV $18.20 CA $23.20 $275 $310 $295 $275 $7 $8 $8 $8 $40 $35 $35 $35 39% 34% 37% 38% 26% 25% 25% 26% After your yearly total drug costs 3 reach $2960, you will pay 45% on brand drugs and 65% of generic drugs After your out-ofpocket drug costs reach $4700, you pay the greater of $2.65 for generic drugs, $6.60 for brand drugs, or 5% coinsurance 1 Amount you pay after the deductible for covered prescriptions until drug costs foryou and the plan reach $2,960 2 Cost-share values are for copays at preferred pharmacies and/or other network standard pharmacies. In instances where two copays are shown, the lowest copay applies to preferred pharmacies. If one copay is shown, there is no preferred pharmacy benefit.
Monthly Annual Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Coverage STATE(S) Premium Deductible Gap SC $126.70 /$4 $3/$7 $45 50% 33% FL AZ NV CA $118.20 /$4 $3/$7 $45 50% 33% $133.70 /$4 $3/$7 $45 50% 33% Aetna Medicare Rx Premier (PDP) Initial coverage 1, 2 $125.00 /$4 $3/$7 $42 50% 33% $145.70 /$4 $3/$7 $45 50% 33% After your yearly total drug costs 3 reach $2960, your coverage continues for Tier 1 drugs and partial coverage for Tier 3 and Tier 4 drugs. You will pay 45% on other brand drugs and 65% of generic drugs on nonsupplemental generic gap coverage Catastrophic Coverage After your out-ofpocket drug costs reach $4700, you pay the greater of $2.65 for generic drugs, $6.60 for brand drugs, or 5% coinsurance 3 The amount you pay out of pocket or others pay on your behalf, plus the amount paid by the plan. 4 Deductible does not apply to Tier 1 drugs. Tier 1 = Preferred Generic, Tier 2 = Non-preferred Generic, Tier 3 = Preferred Brand, Tier 4 = Non-preferred Brand, Tier 5 = Specialty
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include Aetna Health Inc., Aetna Health of California Inc., and or Aetna Life Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. You must have Medicare Part A and Part B to enroll in our plan. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may enroll in a plan only during specific times of the year. To obtain additional information, please contact Aetna Medicare at 1-855-338-7030 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 February 14, and 8 a.m. to 8 p.m., Monday Friday, from February 15 September 30. In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Pharmacy clinical programs, such as prior authorization, step therapy and quantity limits may apply to your prescription drug coverage. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 10 days. You can call 1-888-792-3862 (TTY: 1-800-823-6373), 8 a.m. to 8 p.m., 7 days a week, if you do not receive your mail-order drugs within this timeframe. This information is available for free in other languages. Please call our customer service number at 1-855-338-7030 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 - February 14, and 8 a.m. to 8 p.m., Monday - Friday, from February 15 - September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-855-338-7030 (TTY: 711), de 8 a.m. a 8 p.m., los siete días de la semana, del 1 de octubre al 14 de febrero; de 8 a.m. a 8 p.m., lunes a viernes, del 15 de febrero al 30 de septiembre. Aetna Medicare is a prescription drug plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal.