Benefit Highlights - UnitedHealthcare MedicareRx for Groups (PDP)

Benefit
Highlights
Three prescription drug plans at a glance.
Michigan
The Yearly 4-Stage Cycle
Plan Feature
Formulary
(Drug List)
AARP MedicareRx
Saver
Includes every brand‐name
drug, or its generic version,
covered by Medicare Part D.
AARP MedicareRx
Preferred
Includes 100% of the drugs
covered by Medicare Part D.
AARP MedicareRx
Enhanced
Includes 100% of the drugs
covered by Medicare Part D,
plus coverage for Tier 1 drugs
with copay.
Monthly Premium $25.40 $39.30 $75.20
Tier 1 Copay
Tier 2 Copay
Tier 3 Copay
Specialty Tier
Stage 1:
Annual Deductible
Stage 2:
Initial Coverage
Stage 3:
Coverage Gap
Stage 4:
Catastrophic
Coverage
$5.00
$22.00
$66.95
25% coinsurance
$7.00
$38.00
$94.10
33% coinsurance
$7.00
$39.00
$95.00
33% coinsurance
$295 annual deductible. $0 $0
You + Plan = $2,700: You pay the regular copay or coinsurance for your drugs. The
plan pays the remainder until total drug costs reach $2,700.
You Pay 100%: In the coverage gap, you pay 100% of your drug costs until your yearly
out‐of‐pocket drug costs (not including premiums) equal $4,350.
No coverage. No coverage. Coverage for Tier 1 drugs
with copay.
Plan Pays Majority: After you have reached $4,350 in out-of-pocket costs,
the plan pays the majority of the drug costs until the end of the year. You pay the
greater of $2.40 for generic, $6.00 for brand-name OR 5% of total drug cost.
Plan Service Area
Network
Pharmacies
Value-Added
Benefits
All 50 states, D.C. and the five U.S. territories.
National coverage goes where you go.
More than 60,000 network pharmacies nationwide.
The products and services described below are neither offered nor guaranteed under
our contract with the Medicare program. In addition, they are not subject to the
Medicare appeals process. Any disputes regarding these products and services may be
subject to the AARP ® MedicareRx Enhanced plan grievance process.
None None Plus Drug Discounts
Program: Save 15%–55% 1
on prescription drugs
not normally covered by
Medicare Part D!

For more information, please call UnitedHealthcare at 1-866-530-8934, 24 hours a day, 7 days a week.
TTY users, call 1-877-730-4192. Or visit us at www.AARPMedicareRx.com.
Need more than just prescription drug coverage?
UnitedHealthcare offers health care plans that include built-in prescription drug coverage, plus other coverage
and benefits that matter to you. We hope you’ll take a moment to get acquainted with the plans’ offerings and
find out how you can get more from Medicare!
1
This program provides discounts off the full retail price of prescription drugs not normally covered by Medicare Part D. Program
prices are subject to change and may vary by network pharmacy.
You may enroll in a Medicare prescription drug plan only during specific times of the year. To learn more about all of the possible
enrollment periods, call UnitedHealthcare at 1-866-530-8934, 24 hours a day, 7 days a week (TTY users, call 1‐877‐730‐4192).
Or visit www.AARPMedicareRx.com.
To keep your costs as low as possible, you must fill your prescriptions at a network pharmacy. The AARP MedicareRx Plans’
pharmacy network includes more than 60,000 network pharmacies nationwide including retail, mail order, long‐term care, home
infusion and Indian Health Service, Tribes or Urban Indian (I/T/U) pharmacy services. I/T/U pharmacies are only accessible to
Native Americans and Alaska Natives. They are available to other groups in limited circumstances. If you need to have your
prescription filled at a pharmacy that is not in our network, there are some exceptions allowed for non-routine circumstances
when a member cannot reasonably use network pharmacies. If that happens, you will need to fill out a claim form and you
may not get the same level of discounts as you would through a network pharmacy. For more information about how to order
your prescriptions by mail, please call UnitedHealthcare at 1-866-530-8934, 24 hours a day, 7 days a week (TTY users, call
1‐877‐730‐4192), or mail to AARP MedicareRx Plans, PO Box 29300, Hot Springs, AR 71903‐9300.
The AARP MedicareRx Plans are open to everyone who’s eligible for Medicare in the plan service area of the United States
and U.S. territories. Specifically, a person eligible for this plan: 1) Is entitled to Medicare benefits under Part A or enrolled in
Medicare Part B and 2) Resides in the service area of the Medicare prescription drug plan. You may be enrolled in only one
Medicare prescription drug plan (Part D) at a time.
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
If you are enrolled in an MA coordinated care (HMO or PPO) plan or an MA PFFS plan that includes Medicare prescription drugs,
and then you enroll in a PDP, you will be automatically disenrolled from the HMO, PPO or MA PFFS plan. If you are in a private
fee-for-service plan (PFFS) that does not provide Medicare prescription drug coverage, or an MA Medical Savings Account (MSA)
plan, or in an 1876 Cost plan, you may enroll in a PDP.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help,
call: 1-800-MEDICARE (1-800-633-4227) (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week; or the Social Security
Administration at 1‐800‐772‐1213 between 7 a.m. and 7 p.m., Monday through Friday (TTY users should call 1‐800‐325‐0778); or your
state Medicaid office. Medicare beneficiaries may enroll in AARP MedicareRx Plans through the Centers for Medicare & Medicaid
Services Online Enrollment Center, located at www.medicare.gov. For more information, contact UnitedHealthcare at 1-800-435-0521,
24 hours a day, 7 days a week. TTY users, call 1‐877‐730‐4192. This document is available in alternative formats.
You cannot enroll in AARP MedicareRx Enhanced if your current or former employer helps pay for your drugs.
AARP and its affiliate are not insurance agencies or carriers and do not employ or endorse individual agents.
These Medicare Prescription Drug Plans (PDPs) are insured by United HealthCare Insurance Company or United HealthCare Insurance
Company of New York for New York residents (together called “UnitedHealthcare”). AARP MedicareRx Plans carry the AARP name,
and UnitedHealthcare pays a fee to AARP and its affiliate for use of the AARP trademark and other services. Amounts paid are used
for general purposes of AARP and its members. AARP is not the insurer. UnitedHealthcare contracts with the Federal government as
a PDP sponsor. All decisions about prescription drugs are between you and your physician or other health care provider.
AARP does not make prescription drug plan recommendations for individuals. You are strongly encouraged to evaluate your
needs before choosing a prescription drug plan.
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