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Contact Us

MVP Medicare Customer Care Center
1-800-665-7924
TTY: 1-800-662-1220

Hours

Monday - Friday

8 am - 8 pm (EST)

From Oct. 1 - Feb 14, call seven days a week, 8 am to 8 pm

 

MVP Medicare Product Advisors
1-800-324-3899
TTY: 1-800-662-1220

Hours

Monday - Friday, 8 am - 8 pm (EST)

 

Address

220 Alexander St.

Rochester, NY 14607

 

24/7 Nurse Advice Line

1-800-204-4712

 

Request a Coverage Determination or Formulary Exception

Phone: 855 853-4852

Fax:1-800-401-0915

How MVPs Part D Benefit Works

The Part D prescription drug benefit has different payment stages. What you pay for your prescriptions depends on the stage you are in when a prescription is filled. You will move through these stages as you fill prescriptions during the calendar year.

 

Stage 1: Yearly Deductible Stage
If your plan has a deductible, you start in this payment stage when you fill your first prescription of the year. You will pay 100% of the cost of your drugs until you reach your deductible amount.

 

Note: BasiCare with Part D (PPO), WellSelect with Part D (PPO) and the employer group Basic Prescription Drug Coverage Rider are the only MVP Part D plans that have a deductible. The deductible amount in 2017 for these plans is $400 for Tiers 2-5. For Tiers 1 and 6, you pay no deductible. Once you've spent $400, you move to the Initial Coverage Stage of your Part D benefit.

 

Stage 2: Initial Coverage Stage
If your plan does not have a deductible, you start in this payment stage when you fill your first prescription of the year.

  • You pay your regular tier co-pay for covered prescription drugs. Refer to your Evidence of Coverage (your contract) and plan Riders for your cost share per tier. You can find which tier(s) your drug(s) are in by looking at your Formulary (list of covered drugs).
  • MVP pays a portion of your drug costs in this stage.
  • When the total of what you pay and what MVP pays reaches $3,700, you move to the next payment stage.
  • Note: Some employer group plans do not have a Coverage Gap you continue to pay your regular Tier co-pays until your out-of-pocket costs reach $4,950, then you will move the Catastrophic Coverage Stage. Please refer to your plan Riders for more information about your coverage in the gap.

Stage 3: Coverage Gap Stage
In this payment stage you receive a discount on your prescription drugs.

  • You pay 51% of the cost of generic drugs and 40% of the cost of brand name drugs. These discounts are given automatically at the pharmacy when you fill your prescriptions.

  • If your plan has Tier 1 or Tier 6 $0 co-pays they will continue to be $0 in the Coverage Gap Stage.
    Note: Basic Care with Part D (PPO), WellSelect with Part D (PPO), and employer group Basic Prescription Drug Coverage Rider members will pay a 51% co-insurance for generics and 40% co-insurance for brand name drugs during the Coverage Gap Stage.

  • MVP and brand-name drug manufacturers will pay a portion of your brand drug costs in this stage. The amount that a brand-name drug manufacturer pays toward your prescriptions will count toward your out-of-pocket costs. The amount that MVP pays does not count toward your out-of-pocket costs.
  • When your total out-of-pocket costs reach $4,950, you move to the next payment stage. (This out-of-pocket amount and the rules for counting costs toward the out-of-pocket amount have been set by Medicare.)

Stage 4: Catastrophic Coverage Stage
During this payment stage, the plan pays most of the cost for your covered drugs.

  • You pay the greater of $3.30 for generic drugs, $8.25 for brand-name drugs, or 5% co-insurance.
  • You will remain in this payment stage for the rest of the calendar year (through December 31).

What you pay during these payment stages will vary if you qualify for Low Income Subsidy or Extra Help, have EPIC or VPharm, or if your coverage is through a former employer or union group. Refer to your plan materials for more information about the Part D stages of coverage or call MVPs Medicare Customer Care Center at the number on the back of your Member ID card.

 

 

Last updated: October 2016

Y0051_3227 Approved