Medicare Prescription Drug Plan Benefit Details in Plain Text|
|The following Medicare Prescription Drug plan (PDP) benefits apply to the Health Net Orange Option 1 (PDP) plan (S5678 - 014) in CMS Region 1, which includes all counties in ME NH.|
This plan is administered by HEALTH NET LIFE INSURANCE COMPANY, a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here.
Click here to see this information for the Health Net Orange Option 1 (PDP) plan in a chart format along with the plan enrollment options. We will also send a copy of the plan benefit details chart to your email account.|
|The Health Net Orange Option 1 (PDP) plan has a monthly premium of $39.10. That is $469.20 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.|
|Plan Membership and Plan Ratings|
|The Health Net Orange Option 1 (PDP) plan a new plan in county, therefore we do not yet have membership figures. The Centers for Medicare and Medicaid Services (CMS) has has given this plan carrier a summary rating of 3.00 stars. The detail CMS plan carrier ratings are as follows: a Customer Service Rating of 4 out of 5 stars , a Member Experience Rating of 4 out of 5 stars, and a Drug Cost Information Accuracy Rating of 4 out of 5 stars. |
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $320.00 deductible. That means that you are 100% responsible for the first $320.00 in medication costs and after that is met, the Health Net Orange Option 1 (PDP) plan will share the costs of your medications with you. (See cost-sharing below). $320.00 is the maximum deductible for 2012. There are other plans with a lower deductible or even a $0 deductible. Click here to review plans with a $0 deductible.|
|The following information is about the Health Net Orange Option 1 (PDP) formulary (or drug list). There are 4297 drugs on the Health Net Orange Option 1 (PDP) formulary. the Health Net Orange Option 1 (PDP) does offer a mail order service. Click here to browse the Health Net Orange Option 1 (PDP) Formulary.|
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $320.00, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Health Net Orange Option 1 (PDP) plan’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: Tier 1 contains Preferred Generic Drugs drugs. The tier 1 co-payment is $4.00. Tier 2 contains Preferred Brand Drugs drugs. The tier 2 co-payment is $43.00. Tier 3 contains Non-Preferred Brand Drugs drugs. The tier 3 co-payment is $92.00. Tier 4 contains Non-Preferred Brand Drugs drugs. The tier 4 co-insurance is 25% of the drug costs. Tier 5 contains Specialty Tier Drugs drugs. The tier 5 co-insurance is 25% of the drug costs. Click here to browse the Health Net Orange Option 1 (PDP) Formulary. The Health Net Orange Option 1 (PDP) plan’s Initial Coverage Limit is $2930. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole).|
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 14% of your generic drug prescription costs in the donut hole on your behalf.
The brand-name drug pharmceutical company will pay 50% of the cost of your brand-name drugs pruchased in the donut hole on your behalf. Since the brand-name drug manufacturer pays on
your behalf, the portion that they pay counts toward your TrOOP (or True Out of Pocket) costs. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts.
Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Health Net Orange Option 1 (PDP)) offers No Coverage during the Coverage Gap phase.|