Medicare Part D is Medicare Prescription Drug coverage that covers both brand name and generic prescription drugs. GuideStone’s Care Basic and Care Plus plans include Part D prescription drug coverage. This means that for every plan year, participants’ prescription drug coverage has three “zones”:
How much the participant and the plan spend on prescription drugs — at times calculated together, at times calculated separately — moves the participants through the “zones.” So on both the Care Basic and Care Plus plans, the 2010 prescription drug coverage looks like this:
| Initial Coverage Zone |
Coverage Gap
(aka "donut hole") |
Catastrophic Zone |
- Member pays copays
for covered drugs
(brand and generic).
- Plan pays balance of
drug costs.
- The total of these costs (member copays + plan
payment for drugs) adds up toward the "Coverage Gap." |
- Member pays copays for covered generic drugs only.
- Member pays 100% of drug cost for preferred and non-preferred drugs (brand drugs).
- Only member out-of-pocket costs add up toward the "catastrophic coverage zone."
|
- Member pays the greater of 5% of drug cost or $2.50 generic/
$6.30 for brand name.
- Plan pays the balance of plan cost for the duration of plan year.
|
| Zone continues until total drug spend of $2,830 is reached. |
Zone continues until total member out-of-pocket cost reaches $4,550 (annual). |
Zone continues until January 1 when plans resets. |
Moving through the zones:
- Initial coverage zone. Participants stay in this zone until the total drug spend (that is, member copays + plan payment for drugs) reaches $2,830 in 2010.
- Coverage gap. Also known as the “donut hole.” Participants pay a copay for covered generics and 100% of the drug costs for covered preferred and non-preferred (brand name) drugs. Participants stay in this zone until their total out-of-pocket cost (annual) reaches $4,550.
- Catastrophic coverage zone. Participants who reach this zone pay the greater of 5% drug cost or $2.50 generic/$6.30 for brand name for the duration of the 2010 plan year.
Frequently asked questions about GuideStone Care Plans.