Express Scripts Medicare - Choice (PDP) By Express Scripts Medicare
Express Scripts Medicare - Choice (PDP) is a Enhanced Alternative Medicare Prescription Drug Plan (PART D) by Express Scripts Medicare. Stand-alone plans offer additional prescription drug coverage only and are an option if you are on Original Medicare insurance or you have a Medicare health plan that does not include Part D coverage. The Express Scripts Medicare - Choice (PDP) plan has a monthly drug premium of $86.70 and a $250.00 drug deductible.
2020 Medicare Part-D Plan Details
Express Scripts Medicare - Choice (PDP)
|Provider:||Express Scripts Medicare|
|Monthly Drug Premium:||$86.70|
|Tiers with No Deductible:||1|
Deductible and Premium
The Express Scripts Medicare - Choice (PDP) plan has a monthly drug premium of $86.70 and a $250.00 drug deductible. This Express Scripts Medicare plan offers a $66.30 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $20.40 this Premium covers any enhanced plan benefits offered by Express Scripts Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $86.70. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Express Scripts Medicare - Choice (PDP) medicare insurance plan offers a $61.70 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $68.00 for 75% low income subsidy $74.20 for 50% and $80.50 for 25%.
|Part D Basic Premium:||$66.30|
|Benchmark:||not below the regional benchmark|
|Part D Supplemental Premium||$20.40|
|Benefit Type:||Enhanced Alternative|
|Total Part D Premium:||$86.70|
|$0 Premium with Full LIS:||No|
|Full LIS Premium:||$61.70|
|75% LIS Premium:||$68.00|
|50% LIS Premium:||$74.20|
|25% LIS Premium:||$80.50|
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 75% discount on covered brand-name drugs and a discount on generic drugs. Once you reach the coverage gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 25% on generic drugs unless your plan offers additional coverage. This Express Scripts Medicare plan does offer additional coverage through the gap.
Express Scripts Medicare Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Express Scripts Medicare - Choice (PDP) S5660-212 Formulary here.
Ratings for Express Scripts Medicare - Choice (PDP) S5660
|2019 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|MPF Price Accuracy|
|Drug Adherence for Diabetes Medications|
|Drug Adherence for Hypertension (RAS antagonists)|
|Drug Adherence for Cholesterol (Statins)|
|MTM Program Completion Rate for CMR|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Express Scripts Medicare - Choice (PDP) Drug Plan Customer Service ratings
|Call Center, TTY, Foreign Language|
|Appeals Auto Forward|
Plans as of September 3, 2019.
Star Rating as of October 11, 2019.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change. All contracts for 2020 have been not finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.