Clear Spring Well being is the sixth-largest firm providing Medicare Half D plans. About 464,000 Medicare beneficiaries have Clear Spring Well being Medicare Half D plans as of November 2023.
Clear Spring Well being can’t presently promote or promote Medicare Half D plans to new members. As a result of Clear Spring’s Half D plans have had very poor high quality rankings for 3 consecutive years, the Facilities for Medicare & Medicaid Providers (CMS) sanctioned the corporate. Its Half D plans shall be terminated on the finish of 2024.
Right here’s what it is advisable learn about Clear Spring Well being Medicare Half D prescription drug plans.
Clear Spring Well being Medicare Half D star rankings
Common Half D star ranking, weighted by enrollment: 1.5 stars
The Facilities for Medicare & Medicaid Providers charges Medicare Half D plans on 12 high quality measures. (You will discover definitions for every of those components within the CMS Star Ratings Technical Notes.)
These rankings use a 5-point scale the place 5 is the most effective and 1 is the worst. The company bases its rankings on drug plans’ high quality of service and buyer experiences, and rankings are up to date yearly.
Based mostly on the latest 12 months of information, stand-alone Clear Spring Well being prescription drug plans get a median ranking of 1.5 stars, weighted by enrollment when the rankings have been launched. The 2024 common for all stand-alone Medicare Half D plans from all suppliers, weighted by enrollment, was 3.11 stars.
Medicare Half D plans are required to keep up a abstract ranking of not less than 3 stars to stay in good standing. As a result of Clear Spring Well being has fallen beneath this threshold for 3 consecutive years, the corporate has been sanctioned by CMS, and its Medicare Half D contract will finish on the finish of 2024.
Nonetheless deciding on the proper service? Examine Medicare Half D Plans
Clear Spring Well being Medicare Half D prescription drug plans
Medicare beneficiaries with Unique Medicare (Half A and/or Half B) should buy a Medicare Half D plan for prescription drug protection. Half D plans are bought by personal insurance coverage firms. The prices and protection can fluctuate considerably, so it’s essential to match choices.
Whereas different firms provide as many as three choices, Clear Spring Well being has just one Medicare Half D plan in 2024: Clear Spring Well being Worth Rx. (The corporate not sells its earlier second possibility, Clear Spring Well being Premier Rx).
However proper now, new members can’t enroll in a Clear Spring Medicare Half D plan. As of Oct. 29, 2023, CMS has prohibited Clear Spring from advertising and marketing its Half D plans or enrolling new members attributable to poor high quality rankings.
Members already enrolled in a Clear Spring Medicare Half D plan can select to maintain their protection till the top of 2024 — however they could wish to store for a greater plan earlier than then.
Clear Spring Well being Medicare Half D value
Clear Spring Well being Medicare Half D premiums and deductibles
Clear Spring Well being provides just one Medicare Half D plan in 2024, down from two in 2023.
Premiums for the Clear Spring Well being Worth Rx plan are down just a few {dollars} for 2024, on common. The deductible has gone as much as meet the utmost that plans are allowed to cost in 2024: $545.
Listed below are the 2024 premiums and deductibles for Clear Spring Well being’s stand-alone Medicare prescription drug plan:
Clear Spring Well being Worth Rx (PDP) |
Clear Spring Well being Medicare Half D drug formulary tiers
A formulary is an inventory of the prescribed drugs lined by an insurance coverage plan. The plans typically set up totally different sorts of medicine into tiers in response to the price of the medicine.
Clear Spring Well being prescription drug plans use a five-tier formulary:
Tier 1: Most well-liked generic medicine |
Most generic medicine and a few brand-name medicine. |
Non-preferred generic medicine and a few brand-name medicine. |
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Tier 3: Most well-liked model medicine |
Some brand-name and a few generic medicine. |
Tier 4: Non-preferred medicine |
Non-preferred brand-name medicine and sure generic medicine. |
Generic and brand-name medicine that meet a government-defined threshold for the price of substances. |
Every tier has copay or coinsurance necessities. You’ll typically pay extra for medicine listed in increased tiers as much as Tier 4, however Tier 5 specialty medicine have a decrease coinsurance requirement than Tier 4 medicine.
The medicine included in tiers and what you’ll pay for every tier rely in your selection of prescription drug plan and how much pharmacy you employ. For instance, Clear Spring Well being plans have the bottom copays for prescriptions you fill by means of most well-liked pharmacies, whether or not in-person or by means of the mail, whereas non-preferred pharmacies have increased prices.
$0-deductible choices
There are not any $0-deductible choices from Clear Spring Well being in 2024. The $545 deductible for the Clear Spring Well being Worth Rx plan applies to medicine on all tiers.
$0-copay choices
There are not any $0-copay choices from Clear Spring Well being for 2024. However medicine on Tier 1 and Tier 2 value $1 and $3, respectively, for a 30-day provide from a most well-liked pharmacy.
Copay vs. coinsurance necessities
You’ll wish to test whether or not you’ll pay a copay or coinsurance in your medicines. Copays are set greenback quantities, so it’s simple to see what you’ll pay. Coinsurance is a proportion of the worth in your medicines, so coinsurance necessities will be extra unpredictable and dearer.
The Clear Spring Well being Worth Rx plan has copays for Tiers 1-3 and coinsurance for Tiers 4-5.
Clear Spring Well being Medicare Half D service space
Stand-alone Medicare prescription drug plans from Clear Spring Well being can be found in Washington, D.C., and each state besides New York.
Clear Spring Well being provides its single Medicare Half D plan in all of its markets for 2024 (for present members solely whereas the corporate is barred from enrolling new members).
About Clear Spring Well being
Clear Spring Well being is a subsidiary of Group 1001, a bunch of insurance coverage and monetary providers firms headquartered in Zionsville, Indiana. Group 1001 acquired Neighborhood Care Alliance of Illinois and renamed the enterprise to Clear Spring Well being in 2019. The corporate sells Medicare Benefit and Medicare Half D plans beneath the Clear Spring Well being model.
Group 1001 is a privately held firm with about $60 billion in property beneath administration.
Examine options
Discover the proper Medicare Half D prescription drug plan
The interactive tool on Medicare.gov might help you discover a Medicare Half D plan that covers your prescriptions. It additionally helps you evaluate prices amongst Medicare Half D and Medicare Benefit plans obtainable to you.
Listed below are some issues to remember when evaluating plans:
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Examine the formulary: You’ll wish to be certain that the medicines you presently take and, importantly, any you assume you would possibly want sooner or later, are lined beneath every of the plans you’re contemplating. Discuss to your well being care suppliers about what brand-name and generic medicines to search for and any options which will additionally work in case you’ll be able to’t discover your present medicines on the plans obtainable in your space.
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Search for plan adjustments: Formularies change often. Your insurer ought to ship you a Discover of Plan Change when the formulary adjustments. Learn that doc rigorously.
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Examine the pharmacy community: Most Medicare Half D plans negotiate with a community of pharmacies for the bottom value. Examine to see in case your pharmacy or an equally handy one is within the plan’s community. Additionally, evaluate costs for utilizing mail order.
In case your plan does change, and the change impacts the prescribed drugs you want, you’ll be able to swap plans throughout Medicare’s open enrollment interval, Oct. 15 to Dec. 7. Modifications go into impact on the next Jan. 1.