Medicare beneficiaries can receive subsidized prescription drug coverage through the Medicare Part D program.
Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period.
Beneficiaries who have other sources of drug coverage - through a current or former employer or union, for example - may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the Medicare drug benefit (and therefore considered "creditable coverage"), then the beneficiary can continue to get the high quality care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit.
Creditable Plans
Non-Creditable Benefit Plans
Need more information about Creditable Plans and Part D?
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| Four Tier Copay Plans |
| Tier 1 Copay |
Tier 2 Copay |
Tier 3 Copay |
Tier 4 Copay |
| $10 |
$20 |
$50(1)(3) |
$75 |
| $10 |
$20 |
$50(1)(3) |
$75(2)(3) |
| $10 |
$30 |
$50(1)(3) |
$75(2)(3) |
(1) Tier Three: Greater of $50 copay or 20% Coinsurance limited to $250 Per Script Per Month
(2) Tier Four: Greater of $75 copay or 20% Coinsurance limited to $250 Per Script Per Month
(3) $3,000 Annual Out of Pocket Maximum for Tier 3 and 4 Combined
| Copay Plans with Deductibles |
| Tier 1 Copay |
Tier 2 Copay |
Tier 3 Copay |
Tier 4 Copay |
Deductible |
| $10 |
$30 |
$50(1)(3) |
$75(2)(3) |
$50 |
| $10 |
$30 |
$50(1)(3) |
$75(2)(3) |
$75(3) |
| $10 |
$30 |
$50(1)(3) |
$75(2)(3) |
$100(3) |
| $10 |
$30 |
$50(1)(3) |
$75(2)(3) |
$150(3) |
(1) Tier Three: Greater of $50 copay or 20% coinsurance limited to $250 per script per month
(2) Tier Four: Greater of $75 copay or 20% coinsurance limited to $250 per script per month
(3) $3,000 annual out-of-pocket maximum for tier 3 or 4 combined
Miscellaenous Plan Descriptions
- $10/$30/$50 copay with $5,000 annual maximum benefit
- $50 Annual Deductible, then $10/30%/50% copay with percent copays limited to $20 minimum and $100 maximum
- $50 annual deductible, then 20% coinsurance
- $5 copay in-network for formulary generic and brand (when no generic is available)
| HRA Plans |
| Deductible |
Coinsurance |
OOP Max |
Rx Copay |
| $1,500 |
0% |
$1,500 |
$10/30/50/100 |
| $1,500 |
10% |
$3,000 |
$10/30/50/100 |
| $1,500 |
20% |
$4,000 |
$10/30/50/100 |
| $2,500 |
0% |
$2,500 |
$10/30/50/100 |
| $2,500 |
10% |
$4,000 |
$10/30/50/100 |
| $2,500 |
20% |
$4,500 |
$10/30/50/100 |
| $3,000 |
0% |
$3,000 |
$10/30/50/100 |
| $3,000 |
10% |
$4,500 |
$10/30/50/100 |
| $3,000 |
20% |
$5,000 |
$10/30/50/100 |
| $4,000 |
0% |
$4,000 |
$10/30/50/100 |
| $4,000 |
20% |
$6,000 |
$10/30/50/100 |
| $5,000 |
0% |
$5,000 |
$10/30/50/100 |
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Plans deemed not creditable for deferment of Part D coverage
- HSA Equity and HRA Design Plans (see table below):
| HSA Plans |
| Deductible |
Coinsurance |
OOP Max |
Rx Copay After Deductible |
| $2,500 |
0% |
$3,500 |
$10/30/50/100 |
| $2,500 |
10% |
$4,000 |
$10/30/50/100 |
| $2,500 |
20% |
$4,500 |
$10/30/50/100 |
| $3,000 |
0% |
$4,000 |
$10/30/50/100 |
| $3,000 |
10% |
$4,500 |
$10/30/50/100 |
| $3,000 |
20% |
$5,000 |
$10/30/50/100 |
| $4,000 |
0% |
$5,950 |
$10/30/50/100 |
| $4,000 |
20% |
$5,950 |
$10/30/50/100 |
| $5,000 |
0% |
$5,950 |
$10/30/50/100 |
| HRA Plans |
| Deductible |
Coinsurance |
OOP Max |
Rx Copay After Deductible |
| $3,000 |
10% |
$4,500 |
$10/30/50/100 |
| $3,000 |
20% |
$5,000 |
$10/30/50/100 |
| $4,000 |
0% |
$5,950 |
$10/30/50/100 |
| $4,000 |
20% |
$5,950 |
$10/30/50/100 |
| $5,000 |
10% |
$5,950 |
$10/30/50/100 |
| Essential and Standard PPO Plans |
| RX Coinsurance |
|
Rx Copay After Deductible |
| 30% |
For up to a 90 day supply |
limited to generic drugs unless generic is not available. |
| 50% |
For up to a 90 day supply |
limited to generic drugs unless generic is not available. |
| Essential and Standard HMO Plans |
| RX Coinsurance |
|
Rx Copay After Deductible |
| $10 |
For up to a 90 day supply |
limited to generic drugs unless generic is not available. |
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Need more information about Part D and creditable plans? Visit the Centers for Medicaid and Medicare Web site.
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Have questions or are unable to determine if your plan meets the requirements? Contact us.
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