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1. Standard Medicare Part D Benefit, 2006 FPL=federal poverty limit
This is a graphical representation of the “standard” benefit structure for patients earning more than 150% of the FPL.
Following a $250 deductible, there will be a 25% co-insurance.
$2,850 coverage gap is commonly referred to as the “doughnut hole,” during which patient pays all costs.
Catastrophic coverage kicks in at an patient out-of-pocket expenditure level of $3,600, regardless of wrap-around coverage.
One can see how patients with the highest annual expenditures will experience a great deal of relief, as evidenced by the activation of the “catastrophic” coverage at 5% patient co-insurance following the doughnut hole gap.FPL=federal poverty limit
This is a graphical representation of the “standard” benefit structure for patients earning more than 150% of the FPL.
Following a $250 deductible, there will be a 25% co-insurance.
$2,850 coverage gap is commonly referred to as the “doughnut hole,” during which patient pays all costs.
Catastrophic coverage kicks in at an patient out-of-pocket expenditure level of $3,600, regardless of wrap-around coverage.
One can see how patients with the highest annual expenditures will experience a great deal of relief, as evidenced by the activation of the “catastrophic” coverage at 5% patient co-insurance following the doughnut hole gap.
6. Yourx Plan (Medco) Tier 1 Generic $4 retail $4 mail
Tier 2 Brand $17 $34
Tier 3 Nonpreferred 75% 75%
Tier 5 Specialty 25% 25%
Examples:
Tier 2: Zyprexa, Prempro, Viagra, Cellcept
Tier 3: Abilify, Namenda, Vivelle-Dot, Femhrt, Cialis, Micro-K
Tier 5: Gleevac, Copaxone, Avonex, Peg-Intron
7. Aetna
Essentials Plus Prime
Premium $37.83 $49.13 $65.29
Drug list 2 tier closed 2 tier closed 3 tier open
Stage 1 100% $7 Gen / $35 tier 2 $2 Gen / $20 tier 2 / $40 tier 3
0-250
Stage 2 $5 Gen/$25 tier 2 $7 Gen / $35 tier 2 $2 Gen / $20 tier 2 / $40 tier 3
251-2250
Stage 3 100% $7 Gen / 100% $2 Gen / 100% / 100%
>2250
Stage 4 Greater of 5% coinsurance or $2 generic or $5 brand
>3600