2021

PLAN
INFORMATION

How Does Medicare Part D Auto Enrollment Work?

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 will begin January 1, 2021. 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 used brand and generic drugs
  • $0 deductible for many generic drugs
  • Low copays at preferred retail pharmacies, including Walgreens, Walmart and the Kroger Family of Pharmacies
  • Safe and convenient preferred home delivery from Express Scripts Pharmacy® with $0 copay for many generics
  • Pharmacists available 24/7 by phone to answer medication questions, including extensive support for chronic and complex conditions
  • Express Scripts Medicare advisors to provide plan support all year long

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 languages. View information on multi-language interpreter services.

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Extra Help

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 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 2020.
  • You or your authorized representative did not voluntarily choose to enroll in another Medicare prescription drug plan.
  • Your current prescription drug plan has a premium in 2021 that is higher than the minimum amount required by CMS, or your Medicare prescription drug plan is terminating at the end of 2020.

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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 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.

  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: $1.30
    Your copayment for all other drugs is no more than: $4.00
  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: $3.70
    Your copayment for all other drugs is no more than: $9.20

For members automatically enrolled for the 2021 plan year, the premium will vary depending on state of residence. View state level premiums now.

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

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Contact Express Scripts Medicare

If you have any questions, we’re here to help. Call Customer Service 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. TTY users, call 1.800.716.3231. You may also contact Medicare at 1.800.MEDICARE (1.800.633.4227), 24 hours a day, 7 days a week. TTY users, 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.

This information is not a complete description of benefits. Call 1.866.477.5703 (TTY: 1.800.716.3231) for more information.

Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract.
Enrollment in Express Scripts Medicare depends on contract renewal.