Phases of Medicare Part D: Catastrophic Coverage

As people begin to use their Medicare Part D prescription drug plans, they see there are many different parts of this system to learn. As they begin to maneuver through their plans, they see there are different things to learn as well as adjust to. As the insurance members begin to use their benefits, they begin to understand how their insurance will benefit them. As these members have gone through the turbulence of the coverage gap, many are relieved to get to the last portion of their plan, catastrophic coverage.

The deductible phase was a quick introduction to many members of what a prescription drug plan does for them. As they moved out of that phase into the initial coverage phase, many members appreciated their insurance more. The coverage gap happens when the members have used more than $2930 in medications. When this happens, members find themselves having to pay approximately 86% of the negotiated price of their generic medications and as little as 50% of the cost of their brand named medications. When members are prescribed all named brand medications, their costs at the pharmacy can be more than they planned for. Once the costs of their medications have reached $4700, they go into the last phase of coverage, catastrophic coverage.

Catastrophic coverage happens when a member has used their insurance cards to pay for their medications. The costs of their medications have reached a total $4700. Once the total costs of their medications have reached that benchmark, members are in for a surprise, a pleasant surprise. When people go into catastrophic coverage, members find their responsibility at the pharmacy very minimal. They find they can be responsible for as little as 5% of the negotiated price of their medication or a small fee, depending on what their plans stipulate. This is a relief for many people, for many different reasons.

As people go into the catastrophic phase of their insurance, they often find they are at the end of the plan. There are no more phases for them to go through, no other changes to expect and very little they have to do. As people find themselves in this phase of coverage, they often have a lot of questions. Their specific financial responsibility will have to be explained by their insurance provider as it varies from plan to plan.

One of the biggest questions that people have when they go into catastrophic coverage is how long will they stay there. Once a person goes into catastrophic coverage, it lasts until the last day of that year, Dec. 31. If in January a person is prescribed a medication that has a total negotiated price of $5000, they will go through all the phases of their prescription drug plan and right into catastrophic coverage for the rest of the year. Once a person is in this level of coverage, they stay until the end of the year.

Because of all the surprises that most prescription drug plan members have experienced, many want to know if there are any limitations in this stage of their plan. These members are surprised to find there are no limitations when they get to catastrophic coverage. There are no dollar limitations that restrict people from getting their medications. There are also no formulary restrictions. They don't have to worry about not being able to get the medications they are prescribed. As long as the medication is on the formulary, they are able to get their medications.

Most people get to this phase of coverage and are often relieved. Those that have expensive medications they are required to take often feel as if they are at the end of their financial ropes when they come to this phase of their insurance coverage. Most find they are able to financially recover from the expense of having to pay for their medications while they were in the coverage gap. When they realize they will remain in catastrophic coverage until the end of the year, many are thankful they stayed with their insurance up until that point.

Medicare Part D isn't something that is easy for most people to tolerate and deal with. There are a lot of changes that people need to be aware of within their plans as well as limitations. As they begin to get used to one phase of their plan, they may suddenly get thrown into a new one. The phases stop when it comes to catastrophic coverage. Once a person lands in this last level of coverage, they will remain there until the end of the calendar year.

Although there are many benefits to having a prescription drug plan, most don't realize those benefits when they have questions that aren't being answered and addressed. There are many different resources that are available to answer the questions that people have. When a person has questions about their Part D prescription drug plan, they should feel free to call their prescription drug plan provider to ask those questions. If for any reason their questions aren't addressed with their insurance provider, they can also call the Centers for Medicare and Medicaid Services to speak directly with them. The costs of medications aren’t a laughing matter and many people can't afford to ignore them. When there are questions, people need to demand those answers.

Jul. 27 12'
Jeff Gulleson2008/07/24No, we meant high deductible. Catastrophic heatlh insurance is set up to cover a person in a catastrophe and means that minor medical bills would not be covered. Once a person chooses a high deductible he is electing catastrophic coverage and accepting the risk of smaller medical bills. Deductibles can go as high as $25,000 on some policies. Of course the higher the deductible the lower the annual premium.
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