Benefit Changes
PLAN #4000 PART D DRUG BENEFIT FOR 2025
Plan #4000 Part D Drug Benefit for 2025: Navitus MedicareRx (PDP) will continue to administer pharmacy benefits for this plan and CARE will continue to provide you with an “enhanced” Part D prescription drug benefit.
In 2025, there will only be three (3) drug payments stages as part of your Part D benefit as the Coverage Gap Stage will be eliminated. The copayments for Plan Year 2025 will remain the same as Plan Year 2024.
- Annual Deductible: $300
During this stage the member pays 100% of drug costs. After you have met your annual deductible of $300, you will pay the applicable copayment / coinsurance until your total drug costs reach the new Out-of-Pocket amount of $2,000. - Initial Coverage: $300 - $2,000
After you meet your deductible, your plan will help pay for your covered prescription drugs. Your plan will pay some of the cost, and you will pay a copayment or coinsurance. Any amounts paid toward your deductible, as well as copayments / coinsurance paid for your Medicare-covered prescription drugs will go towards the Out-of-Pocket maximum of $2,000. - Catastrophic Coverage: $0 copay for covered Part D drugs
PRESCRIPTION DRUG BENEFIT FOR PLAN YEAR 2024
Navitus MedicareRx (PDP) will administer pharmacy benefits for our Plan #4000 members. CARE will continue to provide you with an “enhanced”, creditable Part D Part D prescription drug benefit.
Annual deductible of $300
Initial Coverage Limit increased from $4,660 to $5,030
Coverage Gap Amount increased from $7,400 to $8,000
Copayments will remain the same for Plan Year 2024
No copayment in the Catastrophic Stage
Your copayments and a brief summary of your prescription drug benefit for Plan Year 2024 are listed below.
Medicare Open enrollment is from October 15th through December 7th, 2023. The benefit period for Plan #4000 is January 1 through December 31.
Please see the chart below for further explanation of the stages plus your copayments for 2024. For questions regarding your prescription drug benefit contact the CARE Customer Service Department at 1.800.334.1330.
Navitus MedicareRx (PDP) Summary of Benefits 2024
Yearly Deductible Stage: During this stage, you pay the full cost of your Part D Drugs. You stay in this stage until you have paid your $300 yearly deductible amount. Once you have paid your deductible amount you move onto the Initial Coverage Stage.
Initial Coverage Stage: During this stage, the plan pays its share for the cost of your drugs and you pay your share of the cost. The table below shows your share of the cost for drugs in each of the plan’s drug tiers. You stay in this stage until the total costs of your Part D drugs reach $5,030, when you move onto the Gap Coverage Stage.
| Cost Sharing Tiers | Network Retail Pharmacy (1-31 day supply) | Network Retail Pharmacy (32 - 90 day supply) | Mail Order Pharmacy (Up to 90-day supply) |
|---|---|---|---|
| Tier 1: Generic products | $15 copayment | $15 copayment | $15 copayment |
| Tier 2: Preferred brand products | $40 copayment | $120 copayment | $100 copayment |
| Tier 3: Non-preferred brand products | $60 copayment | $180 copayment | $150 copayment |
| Tier 4: Specialty products | 25% coinsurance ($250 min, $500 max) | 25% coinsurance ($500 min, $1500 max) | 25% coinsurance ($500 min, $1500 max) |
Gap Coverage Stage: During this stage, you will continue to pay the same cost sharing amount as in the Initial Coverage Stage.
Catastrophic Coverage Stage: $0 Copayment