Stage 1 Stage 2 Stage 3 Stage 4 Yearly Deductible Initial Coverage Coverage Gap Catastrophic Stage Stage Stage Coverage Stage You begin in this During this stage, the During this stage, you pay During this stage, payment stage when plan pays its share of the 35% of the price for brand the plan will pay you fill your first cost of your drugs and name drugs (plus a portion most of the cost prescription of the you pay your share of of the dispensing fee) and of your drugs for year. the cost. 44% of the price for generic the rest of the drugs. calendar year During this stage, You stay in this stage (through until your year-to-date You stay in this stage until you pay the full December 31, cost of your drugs. drug (your your year-to-date “total costs” 2018). payments plus any Part D (your costs” You stay in this payments) total payments) reach a total of (Details are in plan’s stage until you have $3,750 OR $5,000 This amount and Section 7 of this paid $405 for your costs. rules for counting costs chapter.) drugs ($405 is the toward this amount have amount of your (Details are in Section 5 been set by Medicare. deductible). of this chapter.) (Details are in Section 6 of (Details are in this chapter.) Section 4 of this chapter.)
Stage 1 Yearly Deductible Stage Stage 2 Initial Coverage Stage Stage 3 Coverage Gap Stage Stage 4 Catastrophic Coverage Stage You begin in this payment stage when you fill your first prescription of the year. During this stage, you pay the full cost of your drugs. You stay in this stage until you have paid $405 for your drugs ($405 is the amount of your deductible). (Details are in Section 4 of this chapter.) During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your year-to-date “total drug costs” (your payments plus any Part D plan’s payments) total $3,750 OR costs. (Details are in Section 5 of this chapter.) During this stage, you pay 35% of the price for brand name drugs (plus a portion of the dispensing fee) and 44% of the price for generic drugs. You stay in this stage until your year-to-date costs” (your payments) reach a total of $5,000 This amount and rules for counting costs toward this amount have been set by Medicare. (Details are in Section 6 of this chapter.) During this stage, the plan will pay most of the cost of your drugs for the rest of the calendar year (through December 31, 2018). (Details are in Section 7 of this chapter.)
H8067_ISNP_HMO_NONPOS_Model_wRx_v2-MD_EOC.docx