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medicare RX

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 2012 is $4,700 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 $2,930 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 $4,700 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.

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