Medicare Part D Refresher
Confused about Medicare Part D?
Here is an overview of how it works.
Part D is a calendar year benefit: on January 1, all members reset back to Stage 1. Values listed below may change January 1, 2014.
Stage 1: Deductible Stage.
If your plan has a prescription drug deductible, the member pays this amount before benefits start. Most of our employer group plans do not have a deductible.
Stage 2: Initial Coverage Stage.
The member pays copays/coinsurance until the sum total out-of-pocket costs paid by both the member and the plan reach $2,970.
Stage 3: Coverage Gap.
(A) Many of our group plans include coverage in the gap through an employer group wrap-around plan. If this is the case, the member continues to pay copayments/coinsurance until the member’s out-of-pocket costs reach $4,750.
(B) If the plan does not include additional coverage in the gap, the member pays 79% for generic drugs and 47.5% for brand name drugs until the member’s out-of-pocket costs reach $4,750.
Stage 4: Catastrophic Coverage.
In this stage, the member pays the lesser of their initial coverage stage copayments/coinsurance, 5% coinsurance or $2.65 for generics/$6.60 for brand name drugs.
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