How Your Prescription Drug Coverage Works
Know What’s Covered and What You May Pay
Your Elderplan Select (HMO-POS I-SNP/IE-SNP) plan includes Medicare Part D prescription drug Coverage; there is nothing extra to sign up for.
Your drug costs at a glance
What you pay depends on your drug’s tier and whether you fill a 30-day or 90-day supply. The lower the tier, the lower your cost.
| $0 monthly Part D premium | $350 deductible (only for Tier 4 and Tier 5 drugs) | $2,400 annual out-of-pocket maximum once you reach it, you’ll pay $0 for covered Part D drugs for the rest of the year |
| Drug tier | One-month supply (retail or LTC) | 90-day supply (retail) | 90-day supply (mail-order) |
|---|---|---|---|
| Tier 1 — Preferred generic | $0 | $0 | $0 |
| Tier 2 — Generic | $2 | $6 | $4 |
| Tier 3 — Preferred brand | $25 | $75 | $50 |
| Tier 4 — Non-preferred | $100 | $300 | $200 |
| Tier 5 — Specialty | 29% | 29% | 29% |
How your Coverage works throughout the year
Your prescription drug benefit follows three simple stages.
- If you have Tier 4 or Tier 5 medications, you’ll start with the deductible.
- You’ll pay the full cost of those medications until you’ve paid $350.
- If you only take Tier 1, 2, or 3 medications, you skip this step.
- You’ll pay your regular copays.
- Once your deductible is met (or immediately if it doesn’t apply), you’ll simply pay the copay or coinsurance for your medication’s tier.
- Once you reach your annual limit, covered drugs are $0.
- After your yearly out-of-pocket drug costs reach $2,400, you’ll pay nothing for covered Part D medications through December 31.
- We’ll automatically let you know when you’ve reached this stage.
How to Use Your Prescription Drug Benefit
Filling a prescription under your plan is straightforward. You do not need a referral from your Primary Care Provider.
- Find a network pharmacy. Use the search tool on the Find a Pharmacy page. In most cases, your prescriptions are covered only when you fill them at a network pharmacy. If you live in a long-term care facility, you usually use the facility’s pharmacy — confirm that it’s in our network at elderplan.org.
- Bring your prescription and your Elderplan card. Show your Elderplan Member ID card — not your red, white, and blue Medicare card — at every pharmacy visit. If you also have Medicaid, show your Medicaid card too.
- Check whether your drug is on the Drug List. Use the Search for a Covered Drug tool to confirm your medication is covered, see its tier, and check whether any Coverage rules — prior authorization, step therapy, or quantity limits — apply.
- Consider mail-order for medications you take regularly. Through CVS Caremark, you can get up to a 90-day supply of maintenance drugs delivered to your door, often at a lower copay than retail. Call 1-866-490-2102 (TTY: 711), available 24/7, or visit Caremark.com.