PART D 2021

Understanding drug payment stages

Deductible Stage

During this stage, if your plan has a deductible, you usually pay the full cost of your drugs up to the deductible amount. This generally applies to drugs on Tiers 3, 4 and 5.

Once you reach the deductible amount, you pay a copayment or coinsurance in the initial coverage stage.

 

Initial Coverage Stage

During this stage, the plan pays its share of the cost and you pay a copayment or coinsurance (your share of the cost) for each prescription you fill until your total drug costs reach $4130.

Once you reach $4130, you enter the coverage gap or “donut hole.”

 

Coverage Gap Stage

During this stage, you receive limited coverage on certain drugs. You’ll pay 25% of the cost of brand-name drugs (plus part of the dispensing fee) and 25% of the cost of generic drugs. This stage continues until your yearly out-of-pocket drug costs reach $6550.

Once your yearly out-of-pocket costs reach $6550, you move to catastrophic coverage.

Catastrophic Coverage Stage

In this stage, you pay only a small copayment or coinsurance amount for each prescription you fill.

 

 

 

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