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2019 Benefit Changes

ENROLLMENT BENEFIT CHANGE

Members currently enrolled in Plan #4000 have the option of transferring to Plan #4100.  However, please be advised that Plan #4000 members who choose to transfer to Plan #4100 WILL NOT have the option of returning to Plan #4000 once they have made the decision to leave the plan, as enrollment in Plan #4000 has been suspended indefinitely.

 

CARE PLAN #4000 - PRESCRIPTION DRUG BENEFIT (PART D) CHANGE FOR 2019:

For Plan Year 2019, Express Scripts Medicare (PDP) will continue to administer pharmacy benefits for our Plan #4000 members.

bulletAnnual deductible of $300
bulletInitial Coverage Limit increased from $3,750 to $3,820
bulletPrescription Drug Benefit increase from $5,000 to $5,100

CARE will continue to provide you with an "enhanced" Part D prescription drug benefit with no coverage gap known as the "Donut Hole." Your copayments and a brief summary of your prescription drug benefit for Plan Year 2019 are listed below. 

Open enrollment is from October 15th through December 7th. 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 2019. For questions regarding your prescription drug benefit contact the CARE Customer Service Department at 1.800.334.1330.

CARE PLAN #4000 RX BENEFIT FOR 2019

Initial Coverage Stage

 

Deductible

$0 - $3,820

After you have met your annual deductible of $300 you will pay the applicable copayment/coinsurance listed below until your total drug costs reach $3,820.

   Coverage Gap Stage 

$3,820 - $5,100

After your total drug costs reach $3,820, you will continue to pay the same applicable copayment and/or coinsurance listed below as in the Initial Coverage Stage until you reach $5,100.

Catastrophic Coverage Stage

     > Greater than $5,100

After your out-of-pocket drug costs reach $5,100, you will pay the greater of 5% coinsurance or $3.40 for generics (or drugs treated as generic) and $8.50 for all other drugs. The Plan will pay the rest.

TIERS

COPAYMENTS

RETAIL

MAIL ORDER

Up to 31-Day Supply

32 to 90-Day Supply

90-Day Supply

Tier 1: Generic Drugs (lower cost)

$15

$15

$15

Tier 2: Preferred Brand Drugs

$40

$120

$100

Tier 3: Non-Preferred Brand Drugs

$60

$180

$150

Tier 4: Specialty Drugs

33% of drug costs.

$450 Maximum

33% of drug costs.

$1,350 Maximum

33% of drug costs.

$750 Maximum

 

 

 

2018 CARE Benefit Changes

PRESCRIPTION DRUG BENEFIT CHANGES FOR 2018 - Administered by Express Scripts Medicare (PDP):

bulletAnnual deductible of $300 for Plan Year 2018.
bulletDuring the yearly deductible stage, you will pay the full cost of your Part D drugs until you reach your annual deductible of $300. You will remain in this stage until you have paid your deductible amount.
bulletAfter your deductible is met, you will be responsible for any applicable copayment and/or coinsurance throughout the plan year.
bulletIncrease from $4,950 to $5,000 in your prescription drug benefit for Plan Year 2018.

CARE will continue to provide you with an "enhanced" Part D prescription drug benefit with no coverage gap known as the "Donut Hole."

CARE PLAN #4000 RX BENEFIT FOR 2018

Initial Coverage Stage

 

Deductible

$0 - $3,750

After you have met your annual deductible of $300 you will pay the applicable copayment/coinsurance listed below until your total drug costs reach $3,750.

   Coverage Gap Stage

        $3,750 - $5,000

After your total drug costs reach $3,750, you will continue to pay the same applicable copayment and/or coinsurance listed below as in the Initial Coverage Stage until you reach $5,000.

Catastrophic Coverage Stage

     > Greater than $5,000

After your out-of-pocket drug costs reach $5,000, you will pay the greater of 5% coinsurance or $3.35 for generics (or drugs treated as generic) and $8.35 for all other drugs. The Plan will pay the rest.

TIERS

COPAYMENTS

RETAIL

MAIL ORDER

Up to 31-Day Supply

32 to 90-Day Supply

90-Day Supply

Tier 1: Generic Drugs (lower cost)

$15

$15

$15

Tier 2: Preferred Brand Drugs

$40

$120

$100

Tier 3: Non-Preferred Brand Drugs

$60

$180

$150

Tier 4: Specialty Drugs

33% of drug costs.

$450 Maximum

33% of drug costs.

$1,350 Maximum

33% of drug costs.

$750 Maximum

 

 

 

2017 CARE Benefit Changes

PRESCRIPTION DRUG BENEFIT CHANGES FOR 2017 - Administered by Express Scripts Medicare (PDP):

bulletAnnual deductible of $100 for Plan Year 2017.
bulletDuring the yearly deductible stage, you will pay the full cost of your Part D drugs until you reach your annual deductible of $100. You will remain in this stage until you have paid your deductible amount.
bulletAfter your deductible is met, you will be responsible for any applicable copayment and/or coinsurance throughout the plan year.
bulletIncrease from $4,850 to $4,950 in your prescription drug benefit for Plan Year 2017.

CARE will continue to provide you with an "enhanced" Part D prescription drug benefit with no coverage gap known as the "Donut Hole." Your copayments and a brief summary of your prescription drug benefit for Plan Year 2017 are listed on the opposite side of this letter. 

CARE PLAN #4000 RX BENEFIT FOR 2017

Initial Coverage Stage

 

Deductible

$0 - $3,700

After you have met your annual deductible of $100 you will pay the applicable copayment/coinsurance listed below until your total drug costs reach $3,700.

Coverage Gap Stage

$3,700 - $4,950

After your total drug costs reach $3,700, you will continue to pay the same applicable copayment and/or coinsurance listed below as in the Initial Coverage Stage until you reach $4,950.

     Catastrophic Coverage Stage

                 > Greater than $4,950

After your out-of-pocket drug costs reach $4,950, you will pay the

greater of 5% coinsurance or $3.30 for generics (or drugs treated as generic) and $8.25 for all other drugs. The Plan will pay the rest.

TIERS

COPAYMENTS

RETAIL

MAIL ORDER

Up to 34-Day Supply

35 to 90-Day Supply

90-Day Supply

Tier 1: Generic Drugs (lower cost)*

$15

$15

$15

Tier 2: Preferred Brand Drugs

$40

$100

$80

Tier 3: Non-Preferred Brand Drugs

$60

$180

$150

Tier 4: Specialty Drugs

33% of drug costs.

$450 Maximum

33% of drug costs.

$1,350 Maximum

33% of drug costs.

$750 Maximum

Open enrollment is from October 15th through December 7th. 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 2016. For questions regarding your prescription drug benefit contact the CARE Customer Service Department at 1.800.334.1330.

 

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2016 CARE Benefit Changes

CARE PLAN #4000 - PRESCRIPTION DRUG BENEFIT (PART D) CHANGE FOR 2016:

For Plan Year 2016, Express Scripts Medicare (PDP) will continue to administer pharmacy benefits for our Plan #4000 members. CARE will continue to provide our Medicare members with an "enhanced" Part D prescription drug benefit. Your prescription drug benefit has increased from $4,700 to $4,850. You will continue to have no deductible and will only be responsible for applicable copayments and/or coinsurance throughout the plan year. Due to the additional coverage provided by CARE, there will continue to be NO coverage gap, also known as the "Donut Hole."

Open enrollment is from October 15th through December 7th. 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 2016. For questions regarding your prescription drug benefit contact the CARE Customer Service Department at 1.800.334.1330.

CARE PLAN #4000 RX BENEFIT FOR 2016

DEFINITIONS

Total Drug Costs - Drug costs paid by you and the plan.

Out-of-Pocket Drug Costs - Copayment and/or coinsurance paid by you and payments made for your drugs by any of the following programs or organizations: "Extra Help" from Medicare, Medicare’s Coverage Gap Discount Program, etc.

Does NOT include payments made for a) plan premiums, b) drugs not covered by your plan, c) non-Part D drugs (such as drugs you receive during a hospital stay), d) and drugs obtained at a non-network pharmacy that do not meet out-of-network pharmacy access policy.

No Annual Deductible

Initial Coverage Stage

(0 - $3,310)

You will pay the applicable copayment and/or coinsurance listed below until your total drug costs reach $3,310.

Coverage Gap Stage

($3,310 - $4,850)

After your total drug costs reach $3,310, you will continue to pay the same applicable copayment and/or coinsurance listed below as in the Initial Coverage Stage until you reach out-of-pocket drug costs of $4,850.

 

Tiers & Copayments

RETAIL

          HOME DELIVERY

Up to 34-Day Supply

35 to 90-Day Supply

90-Day Supply

Tier 1: Generic Drugs

$15

$15

$15

Tier 2: Preferred Brand Drugs

$40

$90

$70

Tier 3: Non-Preferred Brand Drugs

$60

$180

$150

Tier 4: Specialty Drugs

33% of drug costs.

$300 Maximum

33% of drug costs.

$900 Maximum

33% of drug costs.

$750 Maximum

Reminder: If the cost of the generic drug is less than the $15 copayment, you will pay the lesser price.

Examples: If the cost of the generic drug is $7.50, you will ONLY pay $7.50, NOT the $15 copayment.

If the cost of the generic drug is $25, you will ONLY pay the $15 copayment.

 

Catastrophic Coverage

Stage

> (Greater than $4,850)

After your out-of-pocket drug costs reach $4,850, you will pay the greater of 5% coinsurance or $2.95 for generics (or drugs treated as generic) and $7.40 for all other drugs. The plan will pay the rest.

 

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