The coverage varies depending on the plan you choose, but in general:
- The monthly premiums range from $17.80-$86.90 depending on the coverage.
- Some plans have a $0 deductible, but the maximum deductible is $265 per year.
- After the deductible up to $2400 in medication costs you pay 25% or a specific
copay determined by your plan. Many plans have tiered formularies, which means that
the amount of copay depends on the tier of the medication: tier 1 is generic
medications and the least expensive, tier 2 is preferred brand name medications,
and tier 3 is non-preferred brand name medications, which are the most expensive.
- There is a coverage gap between $2400-$3850 in out of pocket costs, where
most plans offer no coverage and you would have to pay all of the costs.
- Over $3850 in out of packet costs is “catastrophic coverage” for all of the plans where you pay approximately 5% or $2.15 for a one-month supply
of generic medication and $5.35 for a one-month supply of brand name medication,
whichever is greater.