Clear Spring Health is the sixth-largest company offering Medicare Part D plans. About 464,000 Medicare beneficiaries have Clear Spring Health Medicare Part D plans as of November 2023.
Clear Spring Health can’t currently advertise or sell Medicare Part D plans to new members. Because Clear Spring’s Part D plans have had very poor quality ratings for three consecutive years, the Centers for Medicare & Medicaid Services (CMS) sanctioned the company. Its Part D plans will be terminated at the end of 2024.
Here’s what you need to know about Clear Spring Health Medicare Part D prescription drug plans.
Clear Spring Health Medicare Part D star ratings
Average Part D star rating, weighted by enrollment: 1.5 stars
The Centers for Medicare & Medicaid Services rates Medicare Part D plans on 12 quality measures. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.)
These ratings use a 5-point scale where 5 is the best and 1 is the worst. The agency bases its ratings on drug plans’ quality of service and customer experiences, and ratings are updated annually.
Based on the most recent year of data, stand-alone Clear Spring Health prescription drug plans get an average rating of 1.5 stars, weighted by enrollment when the ratings were released. The 2024 average for all stand-alone Medicare Part D plans from all providers, weighted by enrollment, was 3.11 stars.
Medicare Part D plans are required to maintain a summary rating of at least 3 stars to remain in good standing. Because Clear Spring Health has fallen below this threshold for three consecutive years, the company has been sanctioned by CMS, and its Medicare Part D contract will end at the end of 2024.
Still deciding on the right carrier? Compare Medicare Part D Plans
Clear Spring Health Medicare Part D prescription drug plans
Medicare beneficiaries with Original Medicare (Part A and/or Part B) can purchase a Medicare Part D plan for prescription drug coverage. Part D plans are sold by private insurance companies. The costs and coverage can vary significantly, so it’s important to compare options.
Whereas other companies offer as many as three options, Clear Spring Health has only one Medicare Part D plan in 2024: Clear Spring Health Value Rx. (The company no longer sells its previous second option, Clear Spring Health Premier Rx).
But right now, new members can’t enroll in a Clear Spring Medicare Part D plan. As of Oct. 29, 2023, CMS has prohibited Clear Spring from marketing its Part D plans or enrolling new members due to poor quality ratings.
Members already enrolled in a Clear Spring Medicare Part D plan can choose to keep their coverage until the end of 2024 — but they might want to shop for a better plan before then.
Clear Spring Health Medicare Part D cost
Clear Spring Health Medicare Part D premiums and deductibles
Clear Spring Health offers only one Medicare Part D plan in 2024, down from two in 2023.
Premiums for the Clear Spring Health Value Rx plan are down a few dollars for 2024, on average. The deductible has gone up to meet the maximum that plans are allowed to charge in 2024: $545.
Here are the 2024 premiums and deductibles for Clear Spring Health’s stand-alone Medicare prescription drug plan:
Clear Spring Health Value Rx (PDP)
Clear Spring Health Medicare Part D drug formulary tiers
A formulary is a list of the prescription drugs covered by an insurance plan. The plans often organize different kinds of drugs into tiers according to the cost of the drugs.
Clear Spring Health prescription drug plans use a five-tier formulary:
Tier 1: Preferred generic drugs
Most generic drugs and some brand-name drugs.
Non-preferred generic drugs and some brand-name drugs.
Tier 3: Preferred brand drugs
Some brand-name and some generic drugs.
Tier 4: Non-preferred drugs
Non-preferred brand-name drugs and certain generic drugs.
Generic and brand-name drugs that meet a government-defined threshold for the cost of ingredients.
Each tier has copay or coinsurance requirements. You’ll generally pay more for drugs listed in higher tiers up to Tier 4, but Tier 5 specialty drugs have a lower coinsurance requirement than Tier 4 drugs.
The drugs included in tiers and what you’ll pay for each tier depend on your choice of prescription drug plan and what kind of pharmacy you use. For example, Clear Spring Health plans have the lowest copays for prescriptions you fill through preferred pharmacies, whether in-person or through the mail, while non-preferred pharmacies have higher costs.
There are no $0-deductible options from Clear Spring Health in 2024. The $545 deductible for the Clear Spring Health Value Rx plan applies to drugs on all tiers.
There are no $0-copay options from Clear Spring Health for 2024. But drugs on Tier 1 and Tier 2 cost $1 and $3, respectively, for a 30-day supply from a preferred pharmacy.
Copay vs. coinsurance requirements
You’ll want to check whether you’ll pay a copay or coinsurance for your medications. Copays are set dollar amounts, so it’s easy to see what you’ll pay. Coinsurance is a percentage of the price for your medications, so coinsurance requirements can be more unpredictable and more expensive.
The Clear Spring Health Value Rx plan has copays for Tiers 1-3 and coinsurance for Tiers 4-5.
Clear Spring Health Medicare Part D service area
Stand-alone Medicare prescription drug plans from Clear Spring Health are available in Washington, D.C., and every state except New York.
Clear Spring Health offers its single Medicare Part D plan in all of its markets for 2024 (for existing members only while the company is barred from enrolling new members).
About Clear Spring Health
Clear Spring Health is a subsidiary of Group 1001, a group of insurance and financial services companies headquartered in Zionsville, Indiana. Group 1001 acquired Community Care Alliance of Illinois and renamed the business to Clear Spring Health in 2019. The company sells Medicare Advantage and Medicare Part D plans under the Clear Spring Health brand.
Group 1001 is a privately held company with about $60 billion in assets under management.
Find the right Medicare Part D prescription drug plan
The interactive tool on Medicare.gov can help you find a Medicare Part D plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you.
Here are some things to keep in mind when comparing plans:
Check the formulary: You’ll want to make sure the medicines you currently take and, importantly, any you think you might need in the future, are covered under each of the plans you’re considering. Talk to your health care providers about what brand-name and generic medicines to look for and any alternatives that may also work in case you can’t find your current medicines on the plans available in your area.
Look for plan changes: Formularies change frequently. Your insurer should send you a Notice of Plan Change when the formulary changes. Read that document carefully.
Check the pharmacy network: Most Medicare Part D plans negotiate with a network of pharmacies for the lowest cost. Check to see if your pharmacy or an equally convenient one is in the plan’s network. Also, compare prices for using mail order.
If your plan does change, and the change affects the prescription drugs you need, you can switch plans during Medicare’s open enrollment period, Oct. 15 to Dec. 7. Changes go into effect on the following Jan. 1.