How Do Prescription Drug Plans Work?
Here is essential information you need to know about owning a prescription drug plan:
Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different or waived entirely, but the max amount you can be charged is $415 in 2019. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, specialized medications, etc. In 2019, the initial coverage cap is $3,820. After you and the insurance company have paid this amount, you enter the coverage gap.
The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name-brand medications and 37% for generics. Your gap will continue until you spent $5100 out of your pocket in 2019.
Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.
How would I enroll?
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Currently, we represent 10 organizations that offer 76 products in California. Please contact Medicare.gov, 1-800-Medicare, or your local state health insurance plan.