Plan Basics
Contract Year 2021
Medicare Type Medicare Prescription Drug Plan (Part D)
CMS Plan ID S5660-222-000
Plan Organization Express Scripts Medicare
Plan Type Medicare Prescription Drug Plan
Plan Name Express Scripts Medicare - Saver (PDP)
Plan Organization Type PDP
Drugs Covered Prescription Drugs are covered by the prescription drug plan
Doctors Choice Plan Doctors for Most Services
National PDP Y
Benefit Type Enhanced
Special Needs Plan No
Overall Star Rating 3.5
Plan Cost Sharing
Premium $25.90
Monthly Part D Basic Premium $13.50
Monthly Part D Supplemental Premium $12.40
Monthly Part D Total Premium $25.90
Monthly Part D Premium Full Assistance $12.40
Monthly Part D Premium 75% Assistance $15.80
Monthly Part D Premium 50% Assistance $19.10
Monthly Part D Premium 25% Assistance $22.50
Part D Drug Deductible $285.00
Annual Drug Deductible $285.00
Tiers Excluded From Deductible 1
Part D Initial Coverage Limit $4130.00
Part D Catastrophic Coverage Threshold $6550.00
Gap Coverage No
Plan Drug Info
Formulary Link Drug Formulary Directory
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Adams County, Pennsylvania, Allegheny County, Pennsylvania, Armstrong County, Pennsylvania, Barbour County, West Virginia, Beaver County, Pennsylvania, Bedford County, Pennsylvania, Berkeley County, West Virginia, Berks County, Pennsylvania, Blair County, Pennsylvania, Boone County, West Virginia, Bradford County, Pennsylvania, Braxton County, West Virginia, Brooke County, West Virginia, Bucks County, Pennsylvania, Butler County, Pennsylvania, Cabell County, West Virginia, Calhoun County, West Virginia, Cambria County, Pennsylvania, Cameron County, Pennsylvania, Carbon County, Pennsylvania, Centre County, Pennsylvania, Chester County, Pennsylvania, Clarion County, Pennsylvania, Clay County, West Virginia, Clearfield County, Pennsylvania, Clinton County, Pennsylvania, Columbia County, Pennsylvania, Crawford County, Pennsylvania, Cumberland County, Pennsylvania, Dauphin County, Pennsylvania, Delaware County, Pennsylvania, Doddridge County, West Virginia, Elk County, Pennsylvania, Erie County, Pennsylvania, Fayette County, Pennsylvania, Fayette County, West Virginia, Forest County, Pennsylvania, Franklin County, Pennsylvania, Fulton County, Pennsylvania, Gilmer County, West Virginia, Grant County, West Virginia, Greenbrier County, West Virginia, Greene County, Pennsylvania, Hampshire County, West Virginia, Hancock County, West Virginia, Hardy County, West Virginia, Harrison County, West Virginia, Huntingdon County, Pennsylvania, Indiana County, Pennsylvania, Jackson County, West Virginia, Jefferson County, Pennsylvania, Jefferson County, West Virginia, Juniata County, Pennsylvania, Kanawha County, West Virginia, Lackawanna County, Pennsylvania, Lancaster County, Pennsylvania, Lawrence County, Pennsylvania, Lebanon County, Pennsylvania, Lehigh County, Pennsylvania, Lewis County, West Virginia, Lincoln County, West Virginia, Logan County, West Virginia, Luzerne County, Pennsylvania, Lycoming County, Pennsylvania, Marion County, West Virginia, Marshall County, West Virginia, Mason County, West Virginia, Mcdowell County, West Virginia, Mckean County, Pennsylvania, Mercer County, Pennsylvania, Mercer County, West Virginia, Mifflin County, Pennsylvania, Mineral County, West Virginia, Mingo County, West Virginia, Monongalia County, West Virginia, Monroe County, Pennsylvania, Monroe County, West Virginia, Montgomery County, Pennsylvania, Montour County, Pennsylvania, Morgan County, West Virginia, Nicholas County, West Virginia, Northampton County, Pennsylvania, Northumberland County, Pennsylvania, Ohio County, West Virginia, Pendleton County, West Virginia, Perry County, Pennsylvania, Philadelphia County, Pennsylvania, Pike County, Pennsylvania, Pleasants County, West Virginia, Pocahontas County, West Virginia, Potter County, Pennsylvania, Preston County, West Virginia, Putnam County, West Virginia, Raleigh County, West Virginia, Randolph County, West Virginia, Ritchie County, West Virginia, Roane County, West Virginia, Schuylkill County, Pennsylvania, Snyder County, Pennsylvania, Somerset County, Pennsylvania, Sullivan County, Pennsylvania, Summers County, West Virginia, Susquehanna County, Pennsylvania, Taylor County, West Virginia, Tioga County, Pennsylvania, Tucker County, West Virginia, Tyler County, West Virginia, Union County, Pennsylvania, Upshur County, West Virginia, Venango County, Pennsylvania, Warren County, Pennsylvania, Washington County, Pennsylvania, Wayne County, Pennsylvania, Wayne County, West Virginia, Webster County, West Virginia, Westmoreland County, Pennsylvania, Wetzel County, West Virginia, Wirt County, West Virginia, Wood County, West Virginia, Wyoming County, Pennsylvania, Wyoming County, West Virginia, York County, Pennsylvania

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