fasttrack

Medicare Drug Plan

Part D Stages

Medicare Part D plan members may go through different “stages” with their prescription drug coverage. Ultimately, the goal of the stages are to make sure that Medicare can contain costs as much as possible, but it also assists beneficiaries in keeping costs at a minimum as well. They provide a determined dollar amount that may not increased by the company, but companies are allowed to enhance the benefits and make coverage better. For instance, some plans may offer you a lower deductible or lower copays. Some plans may even continue covering your prescriptions at a low cost while you are in the Coverage Gap.

Steps

Step 1: Annual Deductible- Set dollar amount that a beneficiary must pay out of his/ her own pocket before actual plan coverage begins.
Step 2: Initial Coverage Period- Stage where the member and the drug plan share the costs of a medication. Members usually pay a copay and the drug plan pays the remaining amount of the drug costs
Step 3:Catastrophic Stage- Final stage when drug costs for the year have reached a total dollar amount, and members pay a lower share of cost for all medications.
Step 4:Coverage Gap- Stage of coverage where the beneficiary may pay more in costs (25% coinsurance) for a script than they would have in the Initial Coverage stage. Members reach this stage when combined total drug costs for the calendar year have reached a certain dollar amount.