AmeriHealth Rx Option I Prescription Plan for West Virginia Medicare Beneficiaries
| Overall Plan Rating: |  |
|---|---|
| Monthly Premium: | $52.20 |
| Pharmacy Co-Pay: | $315.00 |
| Coverage Limit (ICL): | $2,970.00 |
| Pharmacy Mail Order: | Yes |
| Gap Coverage: | No Gap Coverage |
| Low Income Subsidy: | No |
| Medicare Formulary: | 3624 |
| PDP ID No: | S2321-005 |
| Plan Year: | 2013 |
| Approved by CMS for: | WV Residents |
| Rx Plan Type: | Regional |
| Est. Regional Members: | 7829 |
2018 Medicare Prescription Medication Plan Overview
AmeriHealth Rx Option I (PDP) is an approved Medicare Prescription Drug Plan (Part D) for West Virginia seniors.
The annual premium is $626.40 ($52.20 monthly), and it carries a $315.00 deductible on all prescribed medications. For 2013, the maximum Part D deductible is $325. It goes up a little each year. It went up $5 from last year.
The AmeriHealth Rx formulary ID for this plan is 00012414, and it features 3624 FDA approved medications.
For all West Virginia seniors with Medicare benefits, there are two conditions that can change the amount you pay for your plan. The first is quailfying for the Extra Help program, which lowers your premium. The second is the opposite: if a premium penalty has been imposed on you for not enrolling right away at age 65 open enrollment, then your premium will be marginally higher.
Below are a few plans that are comparable to AmeriHealth Rx Option I:
- SecureRx - Option 3 at $63.80 per month for West Virginia Seniors
- BlueRx Plus at $61.40 per month for West Virginia Seniors
- Medco Medicare Prescription Plan - Choice at $95.40 per month for West Virginia Seniors
AmeriHealth Rx Option I Initial Coverage
In the ICP (Initial Coverage Phase) the cost of your prescriptions is shared with your insurance company. You and the carrier each pay your share (as determined by the plan) until you reach the Initial Coverage Limit (ICL). In 2013, the ICL is $2,970 and this number changes each year. This plan has a deductible that you must pay before ICP cost-sharing ICP begins.
Each prescription medication is put into a tier within each Medicare Part D plan's drug formulary. Different tiers have different levels of cost-sharing. It's important to note that these tiers are not completely standardiszed and your prescriptions may be found in different tiers on differnt plans. This is why we provide access to all Part D plans' drug formularies, so you can compare what the cost is for your prescription drugs for different Part D plasn in your area.
The pharmacy co-pay with the AmeriHealth Rx Option I (PDP) plan in West Virginia is tiered as follows:
| Tier | Co-Pay Amount | Medications in Tier |
|---|---|---|
| 1 | 25% | 1970 Preferred Generics |
| 2 | 25% | 390 Non-Preferred Generics |
| 3 | 25% | 979 Preferred Brands |
| 4 | 25% | 285 Non-Preferred Brands |
| 5 | 0 Specialty Medications | |
The Initial Coverage Limit (ICL) is $2,970.00. This prescription plan does not qualify for the $0 LIS premium.
AmeriHealth Rx Option I (PDP) 2013 Coverage Gap
The Coverage Gap (aka, "Donut Hole") is the coverage phase where you must pay all of your medication costs. Some plans provide donut hole coverage, and if you think that your drug costs will be high enough to get to this level, you should consider a plan with donut hole coverage. You can learn more about costs in the donut hole by reading What is the Medicare Part D Donut Hole? How long it will take you to reach the donut hole with the AmeriHealth Rx Option I (PDP) plan depends on your specific prescriptions.
The Gap Coverage with this policy: You must pay the $3727.50.
Plan Members
Nationwide, the number of seniors using the AmeriHealth Rx Option I policy is 7,829. In region 6 (your region) there are approximately 7,829 people with this policy (based on 2011 CMS statistics).
More Information About AmeriHealth Rx
For more than a decade, AmeriHealth has led the way in bringing quality, affordable health care to more than 265,000 people in New Jersey, Delaware, and Pennsylvania. In its product portfolio, AmeriHealth offers an HMO, a Preferred Provider Organization (PPO), traditional coverage, a Medicare risk program for the senior market, AmeriHealth Mercy Health Plan for Medicaid recipients, and a third-party administration plan, AmeriHealth Administrators®.
AmeriHealth has been recognized for its commitment to providing high quality products. AmeriHealth HMO of New Jersey and Delaware’s AmeriHealth HMO have received the highest possible accreditation by the national leader in HMO quality evaluation. The National Committee for Quality Assurance has awarded both HMOs “Excellent” status for meeting its rigorous evaluation standards.
The summary (overall) rating for this AmeriHealth Rx plan is 3.0 out of 5 based on reviews from 7829 user ratings from the previous year. For more information about the review process, visit http://cms.gov.