There are for stages in PDP. The PDP stages parameters have been changed in 2012. The description below uses the updated numbers. For your convenience, the 2011 numbers are also provided.
1. Yearly Deductible
You pay the first $320 of drug costs before plan starts to pay ($310 in 2011)
2. Initial Coverage
For each covered drug you pay a copayment/coinsurance (defined by the plan), and the plan pays its share. The typical coinsurance is 25%, i.e. you are paying 25% of the drug costs, the insurance company pays the rest. The initial coverage continues until the total drug costs (total of what you’ve paid and what insurance company paid) reaches $2,930 ($2,840 in 2011). You pay a 25% of costs between $321 and $2,930 (between $311 and $2,840 in 2011).
3. Coverage Gap
Once the total costs of prescriptions (paid by you and your plan) has reached $2,930 ($2,840 in 2011), you are paying ALL drug costs until you’ve spent $4,700 out-of-pocket ($4,550 in 2011). This does not include monthly premiums (you must continue to pay them), but include yearly deductible, coinsurance/copayments, and $3,727.50 ($3,607.50 in 2011) while in the coverage gap. In 2012, during the Gap period you'll get the following discounts on your prescriptions: 50% of the price of the plan-covered brand drugs (50% in 2011) and 14% for the plan-covered generic drugs (7% in 2011). Nevertheless, you can count the prescription's full price towards the amount you are required to spend in order to be qualified for catastrophic coverage.
4. Catastrophic Coverage
Once you’ve spent $4,700 out-of-pocket during the year for PDP ($4,550 in 2011), the coverage gap ends and catastrophic coverage begins. You are only paying the greater of either a small 5% coinsurance (5% in 2011) or a small copayment $2.60 for generic drugs ($2.50 in 2011) or $6.50 for brand name drugs ($6.30 in 2011) for each drug until the end of the calendar year.
P.S. The dollar amounts above represent the MAXIMUM of allowed. Some plans may have numbers below the maximum.
1. Yearly Deductible
You pay the first $320 of drug costs before plan starts to pay ($310 in 2011)
2. Initial Coverage
For each covered drug you pay a copayment/coinsurance (defined by the plan), and the plan pays its share. The typical coinsurance is 25%, i.e. you are paying 25% of the drug costs, the insurance company pays the rest. The initial coverage continues until the total drug costs (total of what you’ve paid and what insurance company paid) reaches $2,930 ($2,840 in 2011). You pay a 25% of costs between $321 and $2,930 (between $311 and $2,840 in 2011).
3. Coverage Gap
Once the total costs of prescriptions (paid by you and your plan) has reached $2,930 ($2,840 in 2011), you are paying ALL drug costs until you’ve spent $4,700 out-of-pocket ($4,550 in 2011). This does not include monthly premiums (you must continue to pay them), but include yearly deductible, coinsurance/copayments, and $3,727.50 ($3,607.50 in 2011) while in the coverage gap. In 2012, during the Gap period you'll get the following discounts on your prescriptions: 50% of the price of the plan-covered brand drugs (50% in 2011) and 14% for the plan-covered generic drugs (7% in 2011). Nevertheless, you can count the prescription's full price towards the amount you are required to spend in order to be qualified for catastrophic coverage.
4. Catastrophic Coverage
Once you’ve spent $4,700 out-of-pocket during the year for PDP ($4,550 in 2011), the coverage gap ends and catastrophic coverage begins. You are only paying the greater of either a small 5% coinsurance (5% in 2011) or a small copayment $2.60 for generic drugs ($2.50 in 2011) or $6.50 for brand name drugs ($6.30 in 2011) for each drug until the end of the calendar year.
P.S. The dollar amounts above represent the MAXIMUM of allowed. Some plans may have numbers below the maximum.