|
|
|
Review our plans for:
ZIP code , County
|
|
|
| |
|
Deductible
| $150 | | $0 |
|
For generic drugs
| $7 copay* | | $7 copay* |
|
For preferred brand drugs
| $42 copay* | | $42 copay* |
|
For non-preferred brand drugs
| $72 copay* | | $72 copay* |
|
For specialty drugs
| 25% coinsurance | | 25% coinsurance |
|
You move to Level 2 once YOU and Medi-Pak Advantage pay $2,840.
|
| |
|
For generic drugs
| 93% coinsurance | | 93% coinsurance |
|
For preferred brand drugs
| 100%** | | 100%** |
|
For non-preferred brand drugs
| 100%** | | 100%** |
|
For specialty drugs
| 100%** | | 100%** |
|
You move to Level 3 after your True Out-of-Pocket (TrOOP) reaches $4,550. The $4,550 includes the
amount YOU (not Medi-Pak Advantage) paid in Level 1 and Level 2. To ensure your TrOOP is captured
accurately, use network pharmacies that will file your claims electronically.
|
| |
|
For generic drugs
| $2.50 or 5%
coinsurance, whichever
is greater. | | $2.50 or 5%
coinsurance, whichever
is greater. | |
|
For preferred brand, non-preferred brand and specialty drugs
| $6.30 or 5% coinsurance, whichever is greater. | | $6.30 or 5% coinsurance, whichever is greater. |
|
You remain in Level 3 for the remainder of the calendar year
|
|
Medicare Plans
Return to previous page
|
*
|
34-day supply.
|
|
|
**
|
Important Note: Beginning in 2011, the Medicare Coverage Gap Discount Program will provide manufacturer discounts on
brand-name prescription drugs to Part D enrollees who have reached the coverage gap and are not already
receiving “Extra Help.” A 50% discount will be available for those brand-name drugs from manufacturers
that have agreed to pay the discount. This discount is applied automatically at the time of purchase. Want to hear more good news? Even when you pay 50%, the total cost of the drug (not just the discounted
amount) is applied toward your True Out-of-Pocket (TrOOP).
|
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. This is an advertisement; for more information, contact a benefits specialist.
H4213_Adv 2011 Website Submission CMS Approved 10182010
Web Page Last Updated: 8/30/2011
|