Tips for Comparing Plans
In selecting a Medicare plan, it is important to consider not only current, but future drug costs. Each plan will use a combination of five cost sharing types: premium, deductible, copays/coinsurance, initial coverage limit, and coverage gap.
1. Premium
The monthly cost to participate in a plan. When comparing plans, don’t just look at the plan with the lowest premium. It is best to review total plan costs, including premiums, annual deductibles, co-payments, and prescription drug coverage. You must continue to pay Medicare applicable premiums.
2. Deductible
The amount you pay before the plan begins to pay.
- Zero: You don't have to pay anything before the plan begins to pay.
- Reduced: You pay less than $275 before the plan begins to pay.
- Standard: You pay $275 before the plan begins to pay.
3. Copays/ Coinsurance
The amount you pay out-of-pocket for each prescription drug purchased, office visits, hospital stays, etc.
4. Initial Coverage Limit
The total amount paid by you and your plan until total drug spend * reaches $2,510.
5. Coverage Gap applies to prescription drug plans only
After your total drug spend* reaches $2,510, you will pay 100% for the drugs you take until you reach $4,050 in true out-of-pocket costs (TrOOP). TrOOP is the total you pay in drug costs including deductibles,copays/coinsurances, and amount within the coveragegap.
Note: Your drug costs may vary based on the order in which you purchase your prescriptions, the days supply, and the pharmacy you use.
* Total Drug Spend
The total out-of-pocket (OOP) cost that will be required based on the drugs and plan you have selected. This amount includes the plan premium and total OOP drug cost.
