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Transcript:  Understanding Drug Payment Stages Infographic



Understanding drug payment stages  

Deductible stage 

During this stage, if your plan has a deductible, you usually pay the full discounted cost up to the deductible amount for drugs listed in tiers 3, 4 and 5 of your formulary. (Drugs in tiers 1 and 2 don’t have a deductible because they generally cost less; your copayment for these drugs will be the same whether you have met the deductible or not.)   

Many people will fall into this stage 

Once you reach the deductible amount, you pay a copayment or coinsurance in the initial coverage stage.  

  

Initial coverage stage 

Up to $3,750 

During this stage, you pay a copayment or coinsurance (your share of the cost) for the discounted price of each prescription you fill until your total drug costs (what you and your plan pay) reach $3,750.  

Most people will remain in this stage   

Once you satisfy $3,750, you enter the coverage gap or “donut hole.”  

Coverage gap or “donut hole” stage  

Up to $5,000 

During this stage, your discount is less because you’ll be receiving a minimum level of coverage on brand-name and generic drugs until your yearly out-of-pocket costs reach $5,000.  

Some people will move into this stage 

  

Once your yearly out-of-pocket costs reach $5,000, you move to the catastrophic coverage stage.  

Catastrophic coverage stage 

Through the end of the year  

In this stage, most members will pay only a small copayment or coinsurance amount for each prescription.  

Fewer people reach this stage 

 

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Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.