|Medicare Prescription Drug Plan Benefit Details in Plain Text|
|The following Medicare Prescription Drug plan (PDP) benefits apply to the CommunityCare Prescription Drug Plan (PDP) (S1894 - 001) in CMS Region 23, which includes all counties in OK.|
This plan is administered by COMMUNITYCARE GOVERNMENT PROGRAMS, INC., To switch to a different Medicare Prescription Drug plan or to change your location, click here.
Click here to see the CommunityCare Prescription Drug Plan (PDP) prescription drug benefit details in chart format
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|The CommunityCare Prescription Drug Plan (PDP) has a monthly premium of $20.80. That is $249.60 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full extra help, your monthly premium will be $0. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).|
|The CommunityCare Prescription Drug Plan (PDP) (S1894 - 001) in CMS Region 23 currently has 2,728 members, and 2,728 members in the CommunityCare Prescription Drug Plan (PDP) nationwide.|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $425 deductible. However, formulary drugs on Tier 1 are excluded from the $425 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $425 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the CommunityCare Prescription Drug Plan (PDP) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2020 is $435, but this plan (CommunityCare Prescription Drug Plan (PDP)) has a $425. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.|
|The following information is about the CommunityCare Prescription Drug Plan (PDP) formulary (or drug list). There are 3008 drugs on the CommunityCare Prescription Drug Plan (PDP) formulary. |
The CommunityCare Prescription Drug Plan (PDP) does offer a mail order service.
Click here to browse the CommunityCare Prescription Drug Plan (PDP) Formulary.
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $425, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The CommunityCare Prescription Drug Plan (PDP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: |
The CommunityCare Prescription Drug Plan (PDP)’s Initial Coverage Limit is $4,020. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole).
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (CommunityCare Prescription Drug Plan (PDP)) offers No Coverage during the Coverage Gap phase.