2020

PLAN
INFORMACIÓN

Plan Choice

A great option if you want even more drug coverage, our lowest deductible, and $0 generics (Tier 1) delivered right to you.

Costos del plan

Prima

A premium is a monthly payment for prescription drug coverage.

Deducible anual

A deductible is the amount that you must pay out-of-pocket for prescriptions before the plan begins to pay.

Etapa de cobertura inicial

The Initial Coverage Stage begins after you have met your annual deductible (if your plan has one) and ends when your total drug costs reach the initial coverage limit. In this stage, you will pay the amounts listed based on the drug tier and the pharmacy you use.

What are drug tiers?

What are drug tiers?
Each drug on a formulary (drug list) is placed on a tier, based on its cost. The lower the tier, the less you pay for the drug.

Pref. c/servicio de entrega a dom.
Suministro para 90 días
Categoría 1:
Genérico preferido
$0
Categoría 2:
Genérico
$8
Categoría 3:
Marca preferida
$90
Categoría 4:
Non-preferred drugs
From38% to - 50%
For(30 days)supply
Categoría 5:
Medicamentos especializados
25%
For(30 days)supply
Preferred Retail
Suministro para 30 días
Categoría 1:
Genérico preferido
$1
Categoría 2:
Genérico
$4
Categoría 3:
Marca preferida
$30
Categoría 4:
Non-preferred drugs
From36% to - 48%
For(30 days)supply
Categoría 5:
Medicamentos especializados
25%
For(30 days)supply
Minorista estándar
Suministro para 30 días
Categoría 1:
Genérico preferido
$9
Categoría 2:
Genérico
$12
Categoría 3:
Marca preferida
$39
Categoría 4:
Non-preferred drugs
From38% to - 50%
For(30 days)supply
Categoría 5:
Medicamentos especializados
25%
For(30 days)supply

Etapa de carencia de cobertura

You will enter the Coverage Gap Stage when your total drug costs exceed $4,020. In this stage, you will pay the coinsurance amounts listed.

Etapa de cobertura catastrófica

You will enter the Catastrophic Coverage Stage when your yearly out-of-pocket costs exceed $6,350. In this stage, you will pay the amounts listed.

Monthly premiums and copays/coinsurance may vary by region. For details, please see the Summary of Benefits or call an Express Scripts Medicare advisor. Recuerde que debe continuar pagando su prima de la Parte B de Medicare.

Drug Coverage

The Choice plan Medicare Part D Formulary (drug list) has 3,200 drugs, including the most commonly used medications.

Red de farmacias

In addition to a broad network of standard retail pharmacies and the Express Scripts home delivery pharmacy, our Choice plan offers savings and convenience when using one of the following preferred retail pharmacies:

Walgreens Pharmacy
Kroger

The Kroger Family of Pharmacies includes Dillons, Harris Teeter, Smith's, Ralphs, Pick 'n Save, Metro Market, Mariano's, King Soopers, Fred Meyer, Fry's, City Market, Baker's, Gerbes, Payless, JayC, Owens and QFC.*

Do I have to use a "preferred retail" pharmacy?

Do I have to use a “preferred retail” pharmacy?
You may use any pharmacy in your plan’s network, but you typically pay less when you use a preferred retail pharmacy or home delivery.

Tenga en cuenta: Use our online searchable tool to confirm if your drugs are covered and which pharmacies are in-network. You may also compare all plans offered by Express Scripts Medicare if you are unsure which is best for you.

¿Necesita ayuda?

Call 1.866.477.5703 TTY users: 1.800.716.3231
8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas

*Otras farmacias se encuentran disponibles en nuestra red.

If you qualify for Extra Help from Medicare to pay for your prescription drug costs, the amounts listed here may not apply to you.

Los medicamentos recetados de Medicare Part B no están cubiertos por el beneficio de medicamentos recetados (Part D). Por lo general, solo cubrimos medicamentos recetados, vacunas, productos biológicos e insumos médicos que están cubiertos por el beneficio de medicamentos recetados de Medicare (Part D) y que están incluidos en nuestro formulario.

Express Scripts Medicare's pharmacy network includes limited lower-cost, preferred pharmacies in rural areas in Alaska; the Saver plan also includes limited lower-cost, preferred pharmacies in rural areas in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming; and in suburban areas in Puerto Rico. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call Customer Service at 1.866.477.5703; TTY: 1.800.716.3231, or consult the online pharmacy directory.

Determinados medicamentos recetados tendrán límites de cantidad máxima.

Your prescriber must get prior authorization from Express Scripts Medicare for certain prescription drugs.

Los medicamentos cubiertos por la Parte D pueden obtenerse en farmacias fuera de la red bajo circunstancias determinadas, incluidas enfermedades que se producen cuando la persona está de viaje fuera del área de servicio del plan, donde no hay una farmacia de la red. También es posible que tenga que pagar un costo adicional por medicamentos en una farmacia fuera de la red.

We have free interpreter services available to answer any questions you may have about the plan.
Obtenga información sobre los servicios de intérpretes multilingües.

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