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Medicare Rx Options

The Health Options Program offers three Medicare prescription drug coverage options. You can choose one of these plans with medical coverage (including medical coverage with dental coverage) or on a standalone basis:

  • Enhanced Medicare Rx Option:
    • You have no deductible and pay the least of the three options for certain medications, such as for brand-name drugs in Initial Coverage.
    • Includes coverage of certain medications not covered at all under the Basic Medicare Rx Option, the Value Medicare Rx Option or Medicare prescription drug programs offered by commercial carriers.
    • Has coverage in the Medicare coverage gap, unlike many other plans.
    • Premiums are higher than those for the Basic and Value Medicare Rx Options because the plan provides greater coverage.
    • 2019 Annual Notice of Changes (PDF 535K) for the Enhanced and Basic Medicare Rx Options
    • 2019 Evidence of Coverage (PDF 1.3 MB) for the Enhanced and Basic Medicare Rx Options

  • Basic Medicare Rx Option:
    • This Option has an annual $100 prescription drug deductible (however, it does not apply to generic drugs).
    • The Basic Option provides a lower level of coverage than the Enhanced Medicare Rx Option for certain medications.
    • 2019 Annual Notice of Changes (PDF 535K) for the Enhanced and Basic Medicare Rx Options
    • 2019 Evidence of Coverage (PDF 1.3 MB) for the Enhanced and Basic Medicare Rx Options
  • Value Medicare Rx Option:
    • Your monthly premium is lower than the Enhanced and Basic Medicare Rx Options.
    • You have to satisfy Medicare's $415 annual deductible before this plan pays any portion of your prescription drug expenses.
    • You get financial protection in the event of unexpected high-cost prescription drug expenses.
    • After you meet the annual deductible, you pay 25% of the cost of any medication in Initial Coverage.
    • 2019 Annual Notice of Changes (PDF 536K) for the Value Medicare Rx Option
    • 2019 Evidence of Coverage (PDF 1.2 MB) for the Value Medicare Rx Option

Prescription Drug Options at a Glance

Click on the links below for an overview of the benefits under each Option.

The Health Options Program Formulary

The Enhanced, Basic and Value Medicare Rx Options include a formulary, which is a list of the medications covered under each Option. The Enhanced and Basic Medicare Rx Options have the same formulary. The Value Medicare Rx Option uses a different formulary. There are certain medications that are covered only under the Enhanced Medicare Rx Option. Medicare requires plans to submit a formulary list of drugs to be covered under an approved Medicare prescription drug plan.

We developed a custom formulary for the Enhanced and Basic Medicare Rx Options that covers almost all of the medications that current Health Options Program participants had filled over the last year. Not all drugs are included under the Enhanced, Basic and Value Medicare Rx Options. Generic drugs for covered categories are always included.

For more information about the Enhanced, Basic and Value Medicare Rx Options, refer to the many Medicare Rx resources on this site:

Last modified April 2, 2019