2021 Amerivantage Rx Basic (PDP) By Amerigroup

Amerivantage Rx Basic (PDP) is a Basic Alternative 2021 Medicare (Part-D) Prescription Plan by Amerigroup. 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 Amerivantage Rx Basic (PDP) plan has a monthly drug premium of $40.00 and a $380.0 drug deductible.

S8182-003 Part-D Summary of Bennefits

Plan Name:
Amerivantage Rx Basic (PDP)
Provider: Amerigroup
Plan ID:
Plan Year:2021
State: Arizona
Benefit Type: Basic
Monthly Drug Premium: $40.00
Drug Deductible: $380.0
Tiers with No Deductible: 0
Gap Coverage: No
National Plan: No
Similar Plan: S8182-004

Deductible and Premium for Amerivantage Rx Basic (PDP)

The Amerivantage Rx Basic (PDP) plan has a monthly drug premium of $40.00 and a $380.0 drug deductible. This Amerigroup plan offers a $40.00 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 $- this Premium covers any enhanced plan benefits offered by Amerigroup 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 $40.00. 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.

Part D Basic Premium: $40.00
Benchmark: not below the regional benchmark
Part D Supplemental Premium $-
Benefit Type: Basic Alternative
Total Part D Premium: $40.00

Amerigroup Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Amerivantage Rx Basic (PDP) medicare insurance plan offers a $3.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $12.90 for 75% low income subsidy $22.00 for 50% and $31.00 for 25%.

$0 Premium with Full LIS: No
Full LIS Premium: $3.90
75% LIS Premium: $12.90
50% LIS Premium: $22.00
25% LIS Premium: $31.00

S8182-003 Gap Coverage

In 2021 once you and your plan provider have spent $4130 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 Amerigroup plan does not offer additional coverage through the gap. If you are looking for additional health coverage you can see the Arizona Medigap Plans here.

S8182-003 Formulary or Drug Prices

Amerivantage Rx Basic (PDP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Tier 1 $1 $6
Tier 2 $2 $7
Tier 3 $35 $40
Tier 4 35% 37%
Tier 5 25% 25%
*Initial Coverage Phase and 30 day supply

Source: CMS.
Plans as of September 9, 2020.
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.

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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