Our Part D coverage—planning for the future
Even if you are healthy and don’t take any prescription drugs today, as you age, you may require some form of drug therapy. That’s why Fallon Senior Plan offers a choice of plans that include Medicare prescription drug coverage, so that you can pick one that best suits your needs.
Fallon Senior Plan offers Medicare prescription drug coverage (Part D) through a choice of plans that include two levels of Medicare drug coverage—Basic Rx and Enhanced Rx. (Part D coverage is also included in Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2.)
Coverage for drugs covered by Part D
|
Benefit |
Basic Rx |
Enhanced Rx |
|
|
Deductible |
$275 |
$0 |
|
Up to a 30-day supply of drugs* |
$5 for Tier 1
$20 for Tier 2
$40 for Tier 3 |
$5 for Tier 1
$20 for Tier 2
$40 for Tier 3 |
|
Coverage gap |
After the total yearly drug costs (paid by both you and your plan) reach $2,510, you pay 100% of your prescription drug costs. |
After the total yearly drug costs (paid by both you and your plan) reach $2,510, you pay 100% of your prescription drug costs. |
|
Catastrophic coverage |
After your yearly out-of-pocket drug costs reach $4,050, you pay the greater of:
$2.25 for generic (including brand name drugs treated as generics)
$5.60 for all other drugs, or 5% coinsurance |
After your yearly out-of-pocket drug costs reach $4,050, you pay the greater of:
$2.25 for generic (including brand name drugs treated as generics)
$5.60 for all other drugs, or 5% coinsurance |
*If you receive extra help, your copayments will be lower.
Coverage for drugs not normally covered by Part D
Our formulary includes drugs not normally covered by Medicare Part D. For drugs not normally covered by Medicare Part D (benzodiazepine and barbiturate therapeutic category drugs), you will pay $5 for Tier 1, $20 for Tier 2 or $40 for Tier 3 for up to a 30-day supply of these prescription drugs for the entire 2008 calendar year.
Because these drugs are not normally covered by Medicare Part D, the amounts you pay when you fill a prescription for these drugs do not count toward your total drug costs. This means that the amount you pay does not help you qualify for catastrophic coverage.
For more information
Call us toll-free at 1-888-377-1980 (TDD/TTY: 1-877-608-7677), 8 a.m. to 8 p.m., seven days a week.