Explanation of Benefits (EOB): Your current drug payment stage

Explanation of Benefits (EOB): Your current drug payment stage
Chart 3 shows your current drug coverage payment stage. There are three stages of coverage -- deductible, initial coverage, and catastrophic coverage. Please note, the Inflation Reduction Act (IRA) eliminated the Coverage Gap phase (Donut Hole) at the end of 2024.

All stages will always be shown in this section of the document and your current stage will be highlighted. The language in Chart 3 is customized to fit the member’s current payment stage. Within each stage, there are wording variations. These include variations for plan design (e.g., deductible vs. brand-name/tier level only deductible vs. non-deductible) and for member receiving the Low-Income Subsidy (LIS) (also known as "Extra Help") and non-LIS members.

CHART 3 Your current drug payment stage

The chart below reflects the initial deductible stage for non-Low-Income Subsidy (LIS) Members
The following chart uses the standard text, it is followed by an example chart.

The following is an example on this chart.

CHART 3 Your current drug payment stage Deductible stage non-LIS example

The next chart reflects the Initial Coverage stage for non-Low-Income Subsidy (LIS) Members

Notes on the Deductible column:
If your plan does not have a Deductible stage or you are an Extra Help beneficiary, the deductible column will state "not applicable"
The text shown in the deductible column of the chart is the standard text If the plan has a deductible for all tiers.

If the plan has a brand-name/tier level deductible, text such as "lasts until Out-of-Pocket Costs reach $590 for brand-name (tier 3) drugs" will appear in the deductible column.

• During this payment stage, you (or others on your behalf) pay the full cost of your [brand-name/tier level] drugs.

• You generally pay the full cost of your [brand-name/tier level] drugs until you (or others on your behalf) have paid $[insert deductible amount] for your [brand-name/tier level] drugs ($[insert deductible amount] is the amount of your [brand name/tier level] deductible.) This note applies to all of the charts to follow.

CHART 3 Your current drug payment stage Initial Coverage stage non-LIS example

The next chart reflects the Catastrophic Coverage stage for non-Low-Income Subsidy (LIS) Members

CHART 3 Your current drug payment stage Catastrophic Coverage stage non-LIS example

The charts on this page are provided in the model documents released by the Centers for Medicare and Medicaid Services (CMS).

Navigate the Explanation of Benefits document:

SECTION 1: Your prescriptions during the past month

SECTION 2: Your current drug payment stage

SECTION 3: Your "out-of-pocket costs" and "total drug costs"

SECTION 4: Updates to the plan's Drug List that will affect drugs you take

SECTION 5: If you see mistakes on this summary or have questions, what should you do?

SECTION 6: Important things to know about your drug coverage and your rights

FAQs: Questions and Answers about Explanation of Benefits

Click on a section above for more details and examples.
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