Aspirus Health Plan Medicare 2025 Part D prescription drug coverage
What is Medicare Part D prescription drug coverage?
Medicare Part D helps cover costs for your outpatient prescription drugs and some vaccines that aren't covered under Medicare Part A or Part B. Medicare Part D drug plans offer a formulary (list of covered drugs) with set copays. Most plans with Part D have a monthly premium, benefits and drug costs that vary by plan. Beginning January 1, 2025, your out-of-pocket drug costs won't exceed $2,000. Once you hit that amount in annual drug spending (excluding Aspirus' amount), you pay $0.
Get help paying your drug costs
You may qualify for Extra Help, a Medicare program that helps pay for your Medicare Part D prescription drug plan costs, monthly premium, coinsurance, deductible and more. The amount of Extra Help you get will determine your total monthly premium as a member of our plan. Aspirus Health Plan premium includes coverage for both medical services and prescription drug coverage in many plan options. You can find out if you qualify for Extra Help by calling:
- 1.800.MEDICARE (1.800.633.4227)
(TTY 1.877.486.2048), 24 hours a day, seven days a week - The Social Security Administration at 1.800.772.1213
(TTY 1.800.325.0778), 7 am – 7 pm, Monday – Friday
You can also find information on the Medicare and Social Security Administration websites.
Important documents
- Prescription Drug Claim Form (PDF)
- Request for Medicare Prescription Drug Coverage Determination Form (PDF)
- Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) — coming soon
- Prescription Drug Transition Policy (PDF) — coming soon
Resources
Medicare Prescription Payment Plan — if you have Part D coverage and high out-of-pocket drug costs earlier in the year, you may benefit from participating in this program.
Medication Therapy Management (MTM) — while not a part of the Part D prescription drug benefit, MTM is a pharmacy program sponsored by Aspirus Health Plan available to all Medicare-eligible members who meet program criteria.
Best Available Evidence policy — the Centers for Medicare & Medicaid Services (CMS) created this policy to address incorrect LIS benefit information reflected in their data systems and ensure that Medicare beneficiaries aren’t overcharged for their prescriptions. Learn and download more information on the policy.
Coverage determinations, appeals and grievances — find out how to make a complaint if you have concerns about your Part D coverage.
2025 Medicare Extra Help
The table shows you what your 2025 Aspirus Health Plan monthly plan premium will be if you get Extra Help. This does not include any Medicare Part B premium you may have to pay.
| Your level of Extra Help |
Essential Rx |
| 100% | $0.00 |
| 75% | N/A |
| 50% | N/A |
| 25% | N/A |
Due to the Inflation Reduction Act, all members who were previously eligible for partial Low-Income Subsidy (LIS) benefits are now eligible for full LIS benefits, including premium subsidies. Therefore, there is no 25, 50, or 75% amount displayed due to this act.
Filling your prescriptions
Generally, you must get your prescription drugs from pharmacies in the Aspirus Health Plan network. Find out if your pharmacy is in network, using the pharmacy search tool.
Check if your prescription drugs are covered by searching the formulary page. You can also access your prior authorization and formulary exception criteria documents online as you browse the formulary.
Mail order pharmacy
Save time with free home delivery from Costco Mail Order Pharmacy. You don’t need to be a Costco member to use this service. You may order an extended day supply of some medications and it may cost less than at a retail pharmacy.
Before Costco Mail Order Pharmacy can begin filling your prescriptions, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. Go to the Costco Mail Order Pharmacy website and click "Get Started" or call 1.800.607.6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — found on your member identification (ID) card to complete the patient profile.
Once you have an account and patient profile, choose one of these ways to start getting your drugs at home:
- Call in your prescriptions at 1.800.607.6861 (TTY users call 711)
- Submit your prescriptions at pharmacy.costco.com
- Ask your provider to contact Costco Mail Order Pharmacy
For refills of your mail order prescriptions, you have the option to sign up for an automatic refill reminder program. Typically, you should expect to receive your prescription drugs within 14 business days from the time the mail order pharmacy receives the order.
This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.