|
In addition to paying your monthly premium, you pay these costs each year when using your benefit: |
You Pay |
Plan Pays |
| 1. You pay the first $320 of the cost of covered drugs—this is the annual deductible. |
$320 |
$0 |
| 2. You pay 25% of the cost—your coinsurance—for the next $2,610 in covered drugs. |
$652.50 |
$ 1,957.50 |
| At this point, you reach the initial coverage limit of $2,930. You now move into the coverage gap |
Subtotal
$972.50 |
Subtotal $1,957.50 |
|
3. While in the coverage gap, you pay a share of the cost until you reach $4,700, the maximum in true out-of-pocket costs or TrOOP.
- For brand-name drugs, you pay 50% of the cost of covered drugs and you receive manufacturer discounts for the other 50% of the cost.
- For generic drugs, you pay 86% of the cost of covered drugs and the Plan pays 14% of the cost.
|
Brand-name drugs:
You pay 50% and get a 50% discount
Generic drugs:
86%
|
Brand-name drugs:
$0
Generic drugs:
14% |
|
At this point, the amount you paid and the manufacturer discounts you received equal the maximum in true out-of-pocket (TrOOP) costs. You are now eligible for catastrophic coverage. |
Total
$4,700 |
|
| 4. You pay the greater of 5% of the cost of covered drugs or a minimum copayment of $2.60 for generic drugs or $6.50 for brand-name or specialty drugs. This is your catastrophic coverage. |
5%
No limit |
95%
No limit |