Aetna Medicare Rx Select is a prescription drug plan available in Rhode Island. This 2018 Medicare Part D plan is approved by the Centers for Medicare and Medicaid Services (CMS) for people with Medicare benefits.
Be sure to have a look at the five most important components of the Aetna Medicare Rx Select plan before finalizing your enrollment decision:
- Premium & Deductible: The premium is the amount you pay to be in the plan. This is the monthly cost of membership. In addition, plans may have an annual deductible. This is an amount that you pay towards your prescription costs before cost sharing begins.
- Co-pays & Co-insurance: This is where many people pay more than they should. Prescription co-payments (what you pay at the pharmacy) vary widely based on the formulary tier your drug is in. It's critical to verify that your medications are covered at the lowest tier possible.
- Coverage Phases: All Medicare Part D plans have an initial coverage phase, followed by a coverage gap phase, followed by a catastrophic coverage phase. The phase you're in will largely depend on the cost of your prescriptions. Some plans offer additional coverage in the gap phase. If you have costly medications, look for a plan with additional gap coverage.
- Medication Cost: One of the most challenging aspects of the Medicare Part D program is finding your prescription at the best price. It has as much to do with the pharmacy you use as it does the plan itself. This is because plans have preferred pharmacies and pharmacies have different contracts with pharmaceutical manufactures. Here's a secret, use our friends at GoodRx.com to find your prescription at the best price in your town.
- 5-Star Ratings: Critical measurements, by Medicare, will help you see how well this plan will care for you.
Detailed Cost Information
The Aetna Medicare Rx Select plan does not cover all of your prescription costs. The costs are shared. Your costs includes the monthly premium, an annual deductible (if applicable), and co-payments and/or co-insurance when you pickup your prescriptions.
The annual premium is $212.40 ($17.70 paid monthly). It breaks down as follows:
You can't join the Aetna Medicare Rx Select plan if you have low income subsidy (LIS) benefits.
This plan has a $405.00 deductible (annual).
The Part D deductible is capped at $405 (2018 level). A plan with the maximum deductible is not always more expensive than a similar plan with a lower deductible. You must factor in all costs (premium, deductible, co-pay and pharmacy price).
Your Out-of-Pocket Costs: Premium + Deductible + Co-pay
Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You must also make the required co-payment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).
Your Costs May Be Different
Two conditions may change the amount you pay for this plan. If you qualify for Social Security's Extra Help program your premium could be lower. Also, if did not enroll in a plan when first eligible CMS will impose a penalty on your monthly premium.
Details of Plan Coverage
Aetna Medicare Rx Select is a Enhanced Alternative plan. By law, Aetna Medicare is required to offer a standard benefit package. The standard benefit has an annual deductible, an initial coverage limit, a gap in coverage (donut hole), and a catastrophic coverage phase. Insurance carriers have the option to offer plans that:
- are an actuarial equivalent to the standard benefit; or
- provide enhanced benefits, as compared to the standard benefit.
Most enhanced plans provide additional coverage in the coverage gap phase. If your medications are costly, shop and compare enhanced plans.
Initial Coverage Limit Phase
The ICL is the same for all Rhode Island plans, but it changes from year-to-year. If you enroll in Aetna Medicare Rx Select you share the cost of all covered medications with Aetna Medicare. You each pay your share until $3750.00 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Rhode Island.
Coverage Gap Phase
If you go into the coverage gap phase, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it's possible to hit it quickly if you have expensive long-term prescriptions. That's why it is so important to verify that the Aetna Medicare Rx Select plan offers your medications at the best price before you join.
If you reach the ICL (most seniors don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you're in the gap. You get to the other side of the donut hole when you've spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Enhanced Gap Coverage
Aetna Medicare Rx Select has limited coverage in the gap coverage phase. Call or review the plan's Summary of Benefits for additional information. If you went into the coverage gap phase last year, and could not afford your medications, call with your local Rhode Island Medicaid office and the Social Security Administration (SSA). The SSA's Extra Help program helps people who can't pay for their prescriptions.
Catastrophic Coverage Phase
The final phase is catastrophic coverage. You reach this phase once you've spent $4,950 out-of-pocket. With catastrophic coverage you pay a small co-insurance or co-payment on your covered medication for the remainder of the year.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the Aetna Medicare Rx Select prescription drug plan has co-payments (fixed dollar amount) and/or co-insurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Tier Description|
CRITICAL: To understand how much you will pay at the pharmacy if you join this plan, you must find the tier of each of your prescriptions in the plan's formulary.
TIP: Use the GoodRx Medicare tools to find your prescription at the best price in your town.
CMS 5-Star Ratings
The annual CMS plan ratings are important. Each year CMS rates PDPs across four categories. Ratings offer a good clue as to the quality of service you can expect if you join the plan.
|2018 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|
Aetna Medicare Contact Information
Here's the new member contact information for Aetna Medicare:
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the Aetna Medicare Rx Select prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Cranston, Providence, Warwick, Pawtucket, Woonsocket, Coventry, and all other towns and cities in Rhode Island.
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