Clear Spring Health Medicare Part D 2024 Review

Clear Spring Health is banned from selling its Part D plans. Members can stay in their plan through 2024 but might want to switch sooner.

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Written by Alex Rosenberg
Lead Writer
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Edited by Holly Carey
Assigning Editor
Fact Checked

October 2024

Clear Spring Health's Medicare Part D contract is set to end Dec. 31, 2024. Because of multiple consecutive years of poor ratings, the Centers for Medicare & Medicaid Services (CMS) has sanctioned Clear Spring Health so it can no longer sell or operate Part D plans.

However, Clear Spring Health has appealed CMS’ decision, according to a CMS spokesperson. As a result, Clear Spring Health was allowed to prepare plans and materials for 2025 in the event that CMS’ decision is overturned, the spokesperson said in an email.

CMS declined to comment on when a final decision would be reached.

What's next for Clear Spring Health's Medicare Part D members?

Assuming CMS’ decision to end Clear Spring Health’s Medicare Part D contract isn’t overturned, Clear Spring Health Medicare Part D plans won’t be available in 2025, so members will need to find other Medicare Part D coverage during open enrollment (Oct. 15 through Dec. 7).

Take a look at our picks for the best Medicare Part D plans in 2025 to get started finding the best option for you.

The information below refers to Clear Spring Health’s 2024 Medicare Part D plans, which remain in effect through the end of 2024.

Clear Spring Health is the eighth-largest company offering Medicare Part D plans. About 345,000 Medicare beneficiaries have Clear Spring Health Medicare Part D plans as of September 2024

Centers for Medicare & Medicaid Services. PDP Plan Directory. Accessed Oct 18, 2024.
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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.

Compare against other providers

Wellcare Medicare Part D - Healthpilot

Wellcare

3.5

CMS Star Rating

(855) 922-5051

TTY 711

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on Healthpilot

M-F 9am-6pm, CT

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TTY 711

IS THIS PROVIDER AVAILABLE IN MY STATE?
Cigna Medicare Part D - Healthpilot

Cigna

2.96

CMS Star Rating

(855) 922-5051

TTY 711

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on Healthpilot

M-F 9am-6pm, CT

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(855) 922-5051

TTY 711

IS THIS PROVIDER AVAILABLE IN MY STATE?

Humana Medicare Part D - Healthpilot

Humana

3.48

CMS Star Rating

(855) 922-5051

TTY 711

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on Healthpilot

M-F 9am-6pm, CT

Speak to a licensed insurance agent on Healthpilot.com
(855) 922-5051

TTY 711

IS THIS PROVIDER AVAILABLE IN MY STATE?
AARP/UnitedHealthcare Medicare Part D - Healthpilot

UnitedHealthcare

3.16

CMS Star Rating

(855) 922-5051

TTY 711

Speak to a licensed insurance agent on Healthpilot.com
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on Healthpilot

M-F 9am-6pm, CT

Speak to a licensed insurance agent on Healthpilot.com
(855) 922-5051

TTY 711

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» More options in our roundup of the best Medicare Part D plans

Compare against other providers

Wellcare Medicare Part D - Healthpilot

Wellcare

3.5

CMS Star Rating

(855) 922-5051

TTY 711

Speak to a licensed insurance agent on Healthpilot.com
GET A QUOTE

on Healthpilot

M-F 9am-6pm, CT

Speak to a licensed insurance agent on Healthpilot.com
(855) 922-5051

TTY 711

IS THIS PROVIDER AVAILABLE IN MY STATE?
Humana Medicare Part D - Healthpilot

Humana

3.48

CMS Star Rating

(855) 922-5051

TTY 711

Speak to a licensed insurance agent on Healthpilot.com
Compare My Rates

on Healthpilot

M-F 9am-6pm, CT

Speak to a licensed insurance agent on Healthpilot.com
(855) 922-5051

TTY 711

IS THIS PROVIDER AVAILABLE IN MY STATE?

» More options in our roundup of the best Medicare Part D plans

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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

Centers for Medicare & Medicaid Services. Medicare 2024 Part C & D Star Ratings Technical Notes. Accessed Mar 27, 2024.
. (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

Centers for Medicare & Medicaid Services. Fact Sheet - 2024 Medicare Advantage and Part D Star Ratings. Accessed Mar 27, 2024.
.

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

NerdWallet analysis of CMS data. 2024 Star Ratings Data Tables (Oct 13 2023) (ZIP). Accessed Mar 27, 2024.
. The average for all stand-alone Medicare Part D plans from all providers, weighted by enrollment, was 3.15 stars as of March 2024.

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

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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

Centers for Medicare & Medicaid Services. CY2024_Landscape_Files_Final_20240314 (ZIP). Accessed Mar 27, 2024.
. (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

Centers for Medicare & Medicaid Services. CY2024_Landscape_Files_Final_20240314 (ZIP). Accessed Mar 27, 2024.
:

Plan

Pricing

Clear Spring Health Value Rx (PDP)

Monthly premiums:

  • Lowest: $14.50.

  • Average: $24.66.

  • Highest: $34.30.

Annual deductible: $545.

» If you have concerns about affording Medicare Part D, look into Medicare Extra Help.

$0-deductible options

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

.

$0-copay options

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

Clear Spring Health. Summary of Benefits. Accessed Mar 27, 2024.
.

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. Summary of Benefits. Accessed Mar 27, 2024.
.

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

Centers for Medicare & Medicaid Services. CY2024_Landscape_Files_Final_20240314 (ZIP). Accessed Mar 27, 2024.
.

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.

Compare Medicare Part D companies

Get more information below about some of the major Medicare Part D companies. These insurers offer plans in most states, but specifics may vary depending on your location.

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.

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

Medicare Part D plan review methodology

NerdWallet’s Medicare Part D reviews are based on ratings data from the Centers for Medicare & Medicaid Services (CMS), pricing, cost-sharing requirements, formulary design, consumer experience and more.

NerdWallet reviewed eight Medicare Part D insurance companies based on highest enrollment and greatest online search volume. Together, these eight companies cover about 92% of Medicare beneficiaries with stand-alone Medicare Part D plans, according to CMS data. We review at least five major Medicare Part D companies in every state in the United States.

These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.

Medicare will have big changes in 2025. Compare Medicare Part D Plans