1 / 8

Standard Medicare Part D Benefit, 2006

ahava
Download Presentation

Standard Medicare Part D Benefit, 2006

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    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

More Related