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medicare RX

NRECA's Medicare Part D Plans

We offer five Medicare Part D prescription drug plans for

  • Medicare-eligible retired and disabled employees and directors and
  • their Medicare-eligible spouses, dependent children and surviving spouses

Click the titles below for more information about our plans.

  • Part D Plans: What You Pay

     

    Basic Plan

     Basic Plus Plan

    Copayment Plan

    Enhanced Plan 

    Enhanced Plus Plan

    Deductible

    $310

    $310

    None

    None

    None

    Coinsurance or Copayment

    25%

    25%

    Copayments ranging from $10-$150 per prescription or refill

    25%

    15%

    Coverage Gap

    Generic drugs: 72%

    Brand-name drugs: 47.5%

    Generic drugs: 72%

    Brand-name drugs: 47.5%

    Generic drugs:
    $10-$30 copayment for Tier 1 drugs
    72% for Tier 2-4 drugs

    Brand-name drugs:  47.5%

    No gap. You get 50% discount on your share of cost brand-name drugs

    No gap. You get 50% discount on your share of cost brand-name drugs

    Catastrophic Coinsurance

    5% or a $2.55 or $6.35 copayment

    5% or a $2.55 or $6.35 copayment  

    $0 $0  $0
    Maximum you pay each year*

    Unlimited

    Unlimited $4,550 $4,550 $4,550
    Formulary** Restricted formulary

    Broader formulary -- same for all four plans

    Retail Pharmacy Network

    * Same national pharmacy network, including NRECA's rural pharmacy network
    * Other pharmacies available in NRECA network in addition to CVS pharmacies

    * Does not include premiums.
    ** A formulary is the list of drugs covered by a particular plan. A restricted formulary means that fewer drugs are covered by that plan.

    Premiums 

    The 2014 monthly premiums for our Part D Plans are

    • Basic Plan = $23.65
    • Basic Plus Plan = $38.05
    • Copayment Plan = $83.85
    • Enhanced Plan = $147.75
    • Enhanced Plus Plan = $220.70

    Your premium may be lower if your co-op pays all or some of the cost of your premium, or if you qualify for Extra Help from Medicare. Check with the benefits administrator at your co-op or call the NRECA Member Contact Center.

    Deductible and TrOOP

    Medicare determines some of the costs you pay and they can change from year to year. Here are the costs set by Medicare for 2013:

    • The annual deductible is $310 for those plans requiring a deductible, such as NRECA's Basic and Basic Plus Plans.
    • You must pay $4,550 in True Out-Of-Pocket costs (TrOOP) for covered drugs before you are eligible for catastrophic coverage.
    • For the Basic and Basic Plus Plans only, the minimum copayment during catastrophic coverage is $2.55 for generic drugs and $6.35 for a brand-name or specialty drug.  
  • NRECA's Basic and Basic Plus Plans

    Our Basic and Basic Plus Plans are similar to Medicare’s standard plan.

    In addition to your monthly premium, you pay these costs each year when using your benefit:

    You Pay

    Plan Pays

    1. You pay the first $310 of the cost of covered drugs—this is the annual deductible. 
    $310
    $0
    2. You pay 25% of the cost—your coinsurance—for the next $2,540 in covered drugs.
    $635
    $1,905
    At this point, you reach the initial coverage limit of $2,850. You now move into the coverage gap.
    Subtotal
    $945
    Subtotal $1,905

    3. While in the coverage gap, you pay a share of the cost until you reach $4,550, the maximum in true out-of-pocket costs (TrOOP).

    • For brand-name drugs, you pay 47.5% of the cost of covered drugs and you receive manufacturer discounts for 50% of the cost. The Plan pays 2.5% of the cost. 
    • For generic drugs, you pay 72% of the cost of covered drugs and the Plan pays 28% of the cost.
    Brand-name drugs:
    You pay 47.5% and get a 50% discount

    Generic drugs:
    72%
     
     

    Brand-name drugs:
    2.5%

     

    Generic drugs:

    28%

    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
    $4,550

     
    4. You pay the greater of 5% of the cost of covered drugs or a minimum copayment of $2.55 for generic drugs or $6.35 for brand-name or specialty drugs. This is your catastrophic coverage.

    5%
    No limit

    95%
    No limit

    What's the difference?

    The Basic and Basic Plus Plans are the same plan but have different formularies. The Basic Plan has a more restrictive formulary, meaning that it covers fewer prescription drugs. 

    For the Basic Plan only, you must use the mail-order pharmacy after you get any maintenance medications filled two times at a retail pharmacy. You will need to get a new prescription from your doctor and send it to the mail-order pharmacy. You should ask your doctor for a prescription for a 90-day supply and three refills.  

  • NRECA's Copayment Plan

    With our Copayment Plan, you pay a flat dollar amount for each prescription rather than a percentage of the cost. There are 4 levels, or “tiers,” of drugs, each with a different copayment amount. You pay only the copayment when you use drugs in Tier 1 (most generic drugs), even during the coverage gap, until you are eligible for catastrophic coverage. There is no deductible and no copayment for catastrophic coverage.

    The maximum you pay for 2014 is $4,550 in true out-of-pocket costs.

    Step 1

    For the first $2,850 in total drug costs, you pay only the copayment for each covered drug, depending on the type of drug you choose.

    You Pay

    Plan Pays

    Pharmacy

          Tier 1

       Tier 2    

    Tier 3

    Tier 4

    Retail up to 30 days $10 $35 $50 $75 Drug costs after copayments
    Retail 31-90 days $30 $105 $150

    Up to
    30-day
    supply
    only

    Drug costs after copayments
    Mail order $20 
    for up to
    90-day supply
    $70
    for up to
    90-day supply
    $100
     for up to
    90-day supply

    $75
    for up to
    30-day supply

    Drug costs after copayments

    Step 2

    Then you have a coverage gap, in which you pay a share of the cost until you reach $4,550, the maximum in true out-of-pocket costs (TrOOP).

    You Pay

    Plan Pays

    Pharmacy

    Tier 1   

    Tier 2

    Tier 3

    Tier 4

    Retail up to 30 days $10
    • Brand-name drugs: you pay 47.5% and get 50% discount.
    • Generic drugs: you pay 72%
    Drug costs after copayments
    Retail 31-90 days $30
    • Brand-name drugs: you pay 47.5% and get 50% discount.
    • Generic drugs: you pay 72%
    Drug costs after copayments
    Mail order $20
    • Brand-name drugs: you pay 47.5% and get 50% discount.
    • Generic drugs: you pay 72%
    Drug costs after copayments
    Once the amount you paid and the manufacturer discounts you received equal the maximum in true out-of-pocket (TrOOP) costs, you are eligible for catastrophic coverage.
    $4,550  

    Step 3

    You pay nothing for covered drugs once you reach catastrophic coverage.

    Tier 1: Most generic drugs and some brand-name drugs
    Tier 2: Preferred brand-name drugs and some generic drugs
    Tier 3: Non-preferred brand-name drugs and some generic drugs
    Tier 4: Specialty drugs, both brand-name and generic specialty drugs

  • NRECA's Enhanced Plan

    Instead of a flat dollar copayment, you pay a 25% coinsurance for your covered prescription drugs. There is no deductible, no coverage gap and no coinsurance for catastrophic coverage. The maximum you will pay in 2014 is $4,550 in true out-of-pocket costs (TrOOP).

    In addition to paying the monthly premium, you pay these costs each year when using the benefit:

    You Pay

    Plan Pays

    1. You pay 25% of the drug cost -- your coinsurance -- for covered drugs.

    25%

    75%

    2.Once you reach $2,850 in total drug costs:
    • For brand-name drugs, you pay 50 percent of your 25% coinsurance and you receive manufacturer discounts for the other 50% of your coinsurance.
    • For generic drugs, you pay your 25% coinsurance
    Brand-name drugs:
    12.5% plus 12.5% in discounts

    Generic drugs:
    25%
    Brand-name drugs:
    75%

    Generic drugs:
    75%

    After you reach $4,550 in true out-of-pocket costs, including any amounts you paid and any manufacturer discounts you received, you are eligible for catastrophic coverage.

    3. You pay nothing for covered drugs once you reach catastrophic coverage.

    0%

    100%

     

  • NRECA's Enhanced Plus Plan
    Instead of a flat dollar copayment, you pay a 15% coinsurance for your covered prescription drugs. There is no deductible, no coverage gap and no coinsurance for catastrophic coverage. The maximum you will pay in 2014 is $4,550 in true out-of-pocket costs (TrOOP).

    In addition to paying the monthly premium, you will pay these costs each year when using the benefit:

    You Pay

    Plan Pays

    1. You pay 15% of the cost -- your coinsurance --for covered drugs.

    15%

    85%

    2. Once you reach $2,850 in total drug costs:

    • For brand-name drugs, you pay 50% of your 15% coinsurance and you receive manufacturer discounts for the other 50% of your coinsurance.
    • For generic drugs, you pay your 15% coinsurance

    Brand-name drugs:
    7.5% plus 7.5% in discounts

    Generic:
    15%

    Brand-name drugs:
    85%

    Generic:
    85%

    After you reach $4,550 in true out-of-pocket costs (TrOOP), including any amounts you paid and any manufacturer discounts you received, you are eligible for catastrophic coverage.

    3. You pay nothing for covered drugs once you reach catastrophic coverage.

    0%

    100%

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NRECA is a Medicare-approved Part D Plan sponsor.
This site last updated 9/2014  |  E2332

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