A few notes to help with the understanding of the chart above.
- Plan Name: This is the official plan name from CMS
- Deductible: This is the $250 deductible that was presented in the CMS Standard Plan. Many provider's plans do not have a deductible, however the premium may be higher.
- Co-Pay Tiered Coverage: This is the portion of the plan where the provider and the beneficiary share the costs. Generally speaking, the beneficiary pays $500 out-of-pocket before moving to the Coverage Gap (Donut Hole) portion of the plan. Most of the plans provide a Tiered Drug List for this portion of the plan. In our chart, Yes: means that the plan uses a tiered drug list, therefore, drugs are organized into tiers and you pay a co-payment or co-insurance based on the tier. For Example: Tier 1 drugs: you pay a $5 co-payment, Tier 2: you pay $10, Tier 3: you pay $30. Each plan is different as to which drugs fall into which tiers and how much you pay per Tier. This information can only be found in the plans Formulary. (see link below to CMS) If None is shown in our chart, this means that a 25% co-insurance is applied (as in the CMS Standard Plan).
- Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $2850 in drug costs (the Donut Hole). Many provider's plans cover the costs that fall into this category for an additional premium. In our chart, you will see one of the following None: you must pay the $2850; Generics Only: Generics are covered, but you must pay for Brand Drugs up to $2850; Generic & Brand Drugs: Both are covered by the plan.
- Mail Order: Does the plan permit mail order drugs (remember: only drugs purchased in the U.S. can be covered in the plan).
- Number of the Top 100 Drugs Covered: This column is to give you a feeling for the completeness of the plan. However, it is important to take a look at the formulary for your plan to be sure that your specific drugs are covered.
Please note: The above plan information came from CMS in October 2005.