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Your plan details for
02777 Bristol County

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AARP Medicare Rx Saver from UHC (PDP)

The information provided in this document may be subject to change over time and may become outdated. For the most current and up-to-date information, please refer to our website at UHC.com/medicare.

  • Monthly premium

    new former $69. 50

  • Estimated annual drug cost

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Prescription drug benefits

Learn about this plan's costs for prescription drug coverage.

Annual prescription deductible

$590

Retail network pharmacy (30-day supply)

Tier 1: Preferred Generic Drugs

Preferred network pharmacy (30-day)$2 copayStandard Network pharmacy (30-day)$8 copay

Tier 2: Generic Drugs

Preferred network pharmacy (30-day)$8 copayStandard Network pharmacy (30-day)$10 copay

Tier 3: Preferred Brand Drugs

Preferred network pharmacy (30-day)16% of the costStandard Network pharmacy (30-day)16% of the cost

Tier 3: Insulin

Preferred network pharmacy (30-day)$35 copayStandard network pharmacy (30-day)$35 copay

Tier 4: Non-preferred Drugs

Preferred network pharmacy (30-day)42% of the costStandard Network pharmacy (30-day)45% of the cost

Tier 5: Specialty Drugs

Preferred network pharmacy (30-day)25% of the costStandard Network pharmacy (30-day)25% of the cost

Mail order pharmacy

Tier 1: Preferred Generic Drugs

$6 copay

Tier 2: Generic Drugs

$24 copay

Tier 3: Preferred Brand Drugs

16% of the cost

Tier 3: Insulin

$105 copay

Cost shares if you receive Extra Help

Brand Drugs

Up to $12. 15 copay

Generic Drugs

Up to $4. 90 copay

Cost shares if you receive Extra Help

Brand Drugs

$12. 15

Generic Drugs

$4. 90

Cost shares if you receive Extra Help

Brand Drugs

$4. 80

Generic Drugs

$1. 60

Cost shares if you receive Extra Help

Brand Drugs

$0

Generic Drugs

$0

Plan documents

Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.

Language

General Plan Information

Prescription Drug Coverage

Pharmacy Directory

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General Plan Information

Prescription Drug Coverage

Pharmacy Directory

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Footnotes & disclaimers

footnote
Disclaimer information

 

Enrollment Disclaimer Information:

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company paid royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.

 

Extra Help: 

If you receive Extra Help from Medicare, your copays may be lower or you may have no copays. 

 

The Medicare Prescription Payment Plan: 

Starting Jan. 1, 2025, if you spend more than $2,000 for covered Part D prescription drugs each year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.

 

Other Languages:

This information is available for free in other languages. Please contact Customer Service for additional information. 

 

Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente. 

 

本資訊可以其他語言免費提供。如需更多資訊,請聯絡客戶服務部。 

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