Catastrophic Coverage Threshold –
The Medicare Prescription Drug Plan pays 95% of your drug expenses once the total drug cost reaches $ 9,313.75.00 per year. You pay about 5% of those expenses. There is no maximum limit on the total cost of drugs.
Copayment / Coinsurance – A copayment is a set amount that you must pay each time you fill up a prescription. The copayment amount may vary depending on the drug. A coinsurance is a percentage of the cost of the prescription that a member must pay.
Deductible – An initial amount you must pay before some Medicare prescription drug plans begin to pay. Many plans do not have an initial deductible and the amount of the deductible can vary from plan to plan. The standard deductible for Medicare Part D prescription drug plans is $ 445 for 2021.
Drug Plan Name – Name of the drug plan option. Name of drug sponsor. Name of the parent company of the prescription drug plan.
Initial Coverage Limit –
The initial amount that drug plans will cover after you have paid any annual deductibles and before you reach the coverage gap. The initial coverage limit is $ 4,130.00 for the year 2021. During this period, you can pay an average of 25% of the cost of prescription drugs in copays or coinsurance, and the plan pays an average of 75% of the cost of drugs prescriptions.
Maryland SPDAP Coverage Gap Subsidy–
Once you reach $ 4,130.00 in yearly drug costs. You will enter the coverage gap or donut hole. For Maryland Aging Prescription Drug Assistance Program (SPDAP) members. Who is enrolled in one of 12 Medicare Part D subsidy plan options? They have agreed to offer the gap subsidy coverage of the SPDAP. Prescription drug costs during the coverage gap. Or donut hole will include coinsurance of 5% of the total cost of the prescription plus the cost of the drug. That is not on the form. The remaining prescription drug costs will be covered by any supplemental coverage offered by your plan. Or by any applicable Federal Drug Discount, and the remainder will be covered by the SPDAP.
The subsidy will be provided by using your existing Medicare plan ID card and your ID number. You will not need an additional SPDAP membership card.
Maximum cost per member in the coverage gap –
This is the amount you will have to pay for Medicare prescription drug coverage after the initial coverage limit has been reached. During the coverage gap phase, you are responsible for 100% of drug costs. Until you have paid $ 6,550.00 out of pocket for covered prescription drug costs. Some Enhanced Prescription Drug Plans may provide coverage for some generic drugs during the coverage gap.
Medical management requirements –
Medicare prescription drug plans must implement some strategies (eg, prior authorization, step therapy, quantity limits) through which pharmacists or other qualified healthcare professionals can control specific drugs. Requirements may vary from plan to plan.
Medicare Advantage Plan Summary –
The plan is offered by a private company that has a contract with Medicare to provide you with prescription drugs and Medicare Part A and Part B benefits. A Medicare Advantage plan can be a Health Maintenance Organization ( HMO). A Preferred Provider Organization (PPO), or a Private Fee-for-Service Plan.
Monthly Premium After Subsidy –
Amount of money you will have to pay per month for your premium after the $ 50 monthly subsidy provided by the SPDAP.
Tiers –
Prescription drug plans identify your drugs based on 4 tiers. Each tier may have a different copayment. Tier 1 drugs are generic drugs and generally have the least expensive copay. Tier 4 drugs have the most expensive copay.
Total Monthly Premium –
The monthly payment that you must make to a prescription drug plan or Medicare Advantage plan to receive prescription drug benefits. Premiums vary from plan to plan.
