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The Standard Medicare Benefit
BASIC MATH - Page 21 |
Lucent 2006 PDP |
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If your total drug costs in calendar year 2006 are: |
Medicare Drug Plan Pays |
And you pay (assuming no other drug coverage): |
You pay ( assuming no Med-D or other drug coverage): |
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$0-$250 (Deductible) |
$0 |
Up to $250* |
Medco by Mail - 90 supply:
$20 / generic X4=$80
$50 / formulatory X 4 = $200
$80 / nonformulatory X 4=$320
Out of Pocket maximum =$1,500 |
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$251-$2,250 (initial
coverage) |
75% up to $1,500 |
25% up to $500* |
Medco by Mail - 90 supply:
$20 / generic X 4 =$80
$50 / formulatory X 4 = $200
$80 / nonformulatory X 4 = $320
Out of Pocket maximum = $1,500 |
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$2,250-$5,100 (coverage gap) |
$0 |
100% up to $2,850* |
Medco by Mail - 90 supply:
$20 / generic X 4 = $80
$50 / formulatory X 4 = $200
$80 / nonformulatory X 4 = $320
Out of Pocket maximum =
$1,500 |
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Maximum payments at this level > |
Up to $1,500 |
Up to $3,600 |
Medco by Mail - 90 supply:
$20 / generic X 4 = $80
$50 / formulatory X 4 = $200
$80 / nonformulatory X 4 = $320
Out of Pocket maximum =
$1,500 |
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Over $5,100 (catastrophic coverage) |
95% |
5% or $2 co pay /
generic $5 co pay / brand name |
Medco by Mail - 90 supply:
$20 / generic X 4 = $80
$50 / formulatory X 4 = $200
$80 / nonformulatory X 4 = $320
Out of Pocket maximum = $1,500 |
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* You also pay premiums (about $32 / mo. or $384 a year). With a
$250 deductible, your minimum out of pocket will be $634. Many plans
will offer lower premiums and deductibles. Some will fill in part of
the coverage gap for a higher premium. |
No "by Mail" deductible or premium - Deducible & Co-pays apply
toward $1,500 Out of Pocket Maximum. |
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Medigap Prescription Drug coverage may not
offer a good solution should Lucent PDP coverage be dropped. Medigap
H, I, and J Plans carry premiums of $225 to $287 / person / month
(in Texas) and offer less coverage than Med - D. Plans H & I have a
$1,250 annual limit and cover "Basic Drugs" only, whereas Plan J
offers "Extended Drugs" and a $3,000 limit. According to the AARP's
Special Report (see page 22, question #28),
you may keep Medigap coverage but if you do you
cannot also have Med-D coverage.
Question #28 contains a "Note" that states you
cannot use medigap to pay out-of-pocket costs in Medicare drug
coverage. No new medigap policies covering drugs will be sold after
Jan 1, 2006. There may be other plans
that offer good coverage but those that cover the doughnut hole may
be very expensive. |
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Note: This document is information only. Readers are cautioned to
make an independent analysis and decision. |