Prescription drug coverage levels 2013
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Describes the coverage gap, or "donut hole" of Medicare Part D prescription drug coverage.
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Prescription drug coverage levels 2013
- 1. Medicare Prescription Drug Coverage Levels 2013 Total Drug Beneficiary Insurance Costs $2.65 - $6.60 95% or 5% $4,750 $1,984 100% 0% ( $3,764) ( $0) $6,734 Manufacturer discounts: • brand-name drugs – 52.5% • generic drugs – 21% $986 $1,984 25% 75% ( $661) ( $1,984) $2,970 $325 $0 100% 0% ( $325) ( $0) $325 MAXIMUM
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- Medicare prescription drug coverage is divided into four levels:Deductible – Beneficiary pays 100% of drug costs until the deductible is metDeductible may be zero; it can not exceed $325Ends when beneficiary’s drug costs reach deductible amount In this example, the deductible is $325, all paid by the beneficiary.Initial Coverage – Beneficiary pays a coinsurance (25% is standard), and the plan pays the balanceBegins when beneficiary’s drug costs reach deductible amountEnds when total drug costs, including beneficiary’s and insurance company’s costs, reach $2,970In this example, the beneficiary’s coinsurance is 25%. When total drug costs reach $2,970, the beneficiary has spent $986 and the plan has spent $1,984 (986 + 1984 = 2970).Coverage Gap (“Donut Hole”) – Beneficiary pays 100% of drug costs while in the gapBegins when total drug costs, including beneficiary’s and insurance company’s costs, reach $2,970Ends when beneficiary’s True Out-Of-Pocket costs reaches $4,750 (includes 50% of manufacturers’ discounts on brand-name drugs)Coverage gap starting/ending criteria may differ with some drug plansCosts of brand-name drugs are discounted 52.5% by the manufacturers while in the gap; generic drugs are discounted 21%Catastrophic Coverage – Beneficiary pays a copayment of $2.65 for generics and $6.60 for brand-name drugs, or a 5% coinsurance, and Medicare pays the balanceBegins when beneficiary’s out-of-pocket costs reach $4,750 (includes 50% of manufacturers’ discounts on brand-name drugs)