WPS MedicareRx Plan 1 Prescription Plan for Wisconsin Medicare Beneficiaries
| Overall Plan Rating: |  |
|---|---|
| Monthly Premium: | $44.10 |
| Pharmacy Co-Pay: | $170.00 |
| Coverage Limit (ICL): | $2,970.00 |
| Pharmacy Mail Order: | Yes |
| Gap Coverage: | No Gap Coverage |
| Low Income Subsidy: | No |
| Medicare Formulary: | 3178 |
| PDP ID No: | S5753-006 |
| Plan Year: | 2013 |
| Approved by CMS for: | WI Residents |
| Rx Plan Type: | Regional |
| Est. Regional Members: | 18803 |
2018 Medicare Prescription Medication Plan Overview
WPS MedicareRx 1 (PDP) is an approved Medicare Prescription Drug Plan (Part D) for Wisconsin seniors.
The annual premium is $529.20 ($44.10 monthly), and it carries a $170.00 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 WPS Health Insurance formulary ID for this plan is 00012257, and it features 3178 FDA approved medications.
For all Wisconsin 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 WPS MedicareRx Plan 1:
- First Health Part D Premier Plus at $102.40 per month for Wisconsin Seniors
- Humana Enhanced at $42.10 per month for Wisconsin Seniors
- AARP MedicareRx Preferred at $41.90 per month for Wisconsin Seniors
WPS MedicareRx Plan 1 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 WPS MedicareRx 1 (PDP) plan in Wisconsin is tiered as follows:
| Tier | Co-Pay Amount | Medications in Tier |
|---|---|---|
| 1 | $6.00 | 537 Preferred Generics |
| 2 | $13.00 | 1267 Non-Preferred Generics |
| 3 | $39.00 | 1016 Preferred Brands |
| 4 | 50% | 162 Non-Preferred Brands |
| 5 | 28% | 196 Specialty Medications |
The Initial Coverage Limit (ICL) is $2,970.00. This prescription plan does not qualify for the $0 LIS premium.
WPS MedicareRx 1 (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 WPS MedicareRx 1 (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 WPS MedicareRx Plan 1 policy is 18,803. In region 16 (your region) there are approximately 18,803 people with this policy (based on 2011 CMS statistics).
More Information About WPS Health Insurance
WPS Health Insurance has deep roots in Wisconsin grounded in events that occurred in the mid-1940s. It was a time when many people were having difficulty paying for necessary health care. In response, the State Medical Society developed a low-cost insurance product, called the Wisconsin Plan, which permitted Wisconsin residents to budget the costs of health care. In 1946, the Medical Society established Wisconsin Physicians Service (WPS) to market and administer the plan.
More than 60 years later, affordable health care is still among people's top concerns. WPS is at the forefront, offering flexible, cost-effective health plan solutions to the individual, small group, large group, and senior markets. We offer our members experience, stability, and the personalized service that has become our hallmark.
The summary (overall) rating for this WPS Health Insurance plan is 4.5 out of 5 based on reviews from 18803 user ratings from the previous year. For more information about the review process, visit http://cms.gov.