2017

PLAN
INFORMATION

Medicare Part D Automatic Enrollment

If the Centers for Medicare & Medicaid Services (CMS) has automatically enrolled you in the Express Scripts Medicare Value plan because you qualify for Extra Help and meet certain criteria, you do not need to do anything at this time.

Your coverage begins January 1, 2017. You'll receive materials from Express Scripts Medicare, including a member ID card and information on how to use your prescription drug benefit.

Unsure if you qualify for Extra Help?
Learn more about getting Extra Help with Medicare Part D costs.

Express Scripts Medicare Value plan provides:

  • Coverage for more than 3,000 of the most commonly prescribed medications
  • Over 67,000 network pharmacies, including national chains such as Walgreens and independent pharmacies in your neighborhood
  • Convenient home delivery with free standard shipping from the Express Scripts PharmacySM*
  • Express Scripts Medicare Advisors, who are available 24/7 to answer questions about your benefit
  • Express Scripts pharmacists, who are available by phone 24/7 to answer questions about your medicines
  • Express Scripts specialist pharmacists, who have expertise in the medicines used to treat specific conditions such as diabetes, high blood pressure and high cholesterol

Find your pharmacy or see if your drugs are covered now.

For more details about the Express Scripts Medicare Value plan that you are enrolled in, download the Evidence of Coverage now.

We can answer questions you may have about the plan for free in other lanuages. View information on multi-language interpreter services.

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Extra Help criteria

To have Medicare prescription drug coverage, you must belong to a Medicare-approved prescription drug plan like Express Scripts Medicare. CMS has automatically enrolled or reassigned you to Express Scripts Medicare because you meet the following criteria:

  • You are a full benefit, dual-eligible beneficiary (which means you have both Medicare and Medicaid); you take part in a Medicare Savings Program; or you get Supplemental Security Income (SSI).
    OR
  • You applied and were approved for Extra Help, also called the low-income subsidy (LIS).
  • You have been automatically enrolled into a Medicare prescription drug plan in the past, and you continue to receive Extra Help in 2017.
  • You or your authorized representative did not voluntarily choose to enroll in another prescription drug plan.
  • Your current prescription drug plan has a premium in 2017 that is higher than the minimum amount required by CMS, or your Medicare prescription drug plan is terminating at the end of 2016.

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Medicare will help pay for some or all of your prescription drug costs.

The amount of help you receive depends on your income level and resources. The tables below show how much you will pay for your monthly premium, yearly deductible and prescription drug copayments, based on which situation applies to you. You can also use the amounts shown in the letter you received from CMS to determine your costs.

Please note: Costs and references to retail pharmacies with preferred cost-sharing that appear elsewhere on this website do not apply to you. You will pay the same copayment as set by Medicare at any network pharmacy.

  1. If you have Medicare and full Medicaid coverage, and are receiving in-patient care in a medical institution or skilled nursing facility:

    Your monthly premium is: Varies by Region
    View state level premiums now
    Your yearly deductible is: $0.00
    Your copayment for generic drugs (including brand drugs treated as generics) is no more than: $0.00
    Your copayment for all other drugs is no more than: $0.00
  2. If you have Medicare and full Medicaid coverage, income at or below 100% of the federal poverty level, and are living at home or outside a medical institution or skilled nursing facility:
    Your monthly premium is: Varies by Region
    View state level premiums now
    Your yearly deductible is: $0.00
    Your copayment for generic drugs (including brand drugs treated as generics) is no more than: $1.20
    Your copayment for all other drugs is no more than: $3.70
  3. If you have Medicare and full Medicaid coverage, income above 100% of the federal poverty level, and are living at home or outside a medical institution or skilled nursing facility:

    Your monthly premium is: Varies by Region
    View state level premiums now
    Your yearly deductible is: $0.00
    Your copayment for generic drugs (including brand drugs treated as generics) is no more than: $3.30
    Your copayment for all other drugs is no more than: $8.25

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Contact Express Scripts Medicare

If you have any questions, please call our Express Scripts Medicare Advisors toll free at 1.800.758.4574; New York State residents: 1.800.758.4570. Customer Service is available 24 hours a day, 7 days a week, except Thanksgiving and Christmas. This information is available for free in other languages. TTY users should call 1.800.716.3231. You may also contact Medicare at 1.800.MEDICARE (1.800.633.4227). TTY users should call 1.877.486.2048.

Need help?

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

*Other pharmacies are available in our network. Standard shipping is included as part of your plan.

For members automatically enrolled for the 2017 plan year, the premium will vary depending on state of residence. View state level premiums now.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.

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