Does Partial Extra Help offer Gap coverage?

Mar 10, 2019

  1. wehotex
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    wehotex Guru

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    I’m referring to the 25, 50 & 75 % levels. I seem to recall that one of my Aetna members had this level and they would not give her the 3 for 1 copay rate that they did for. Full Extra Help member. I’m not even sure if they continue to cover the meds at 15% coinsurance in the Gap?
     
    wehotex, Mar 10, 2019
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  2. TwoCents
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    TwoCents Guru

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    Without going down the rabbit hole, here's the definition of "Partial Subsidy" taken from CMS Part D manual Ch 13 "Premium and Cost-Sharing Subsidies for Low-Income Individuals"...

    Partial Subsidy: Partial reductions in a beneficiary’s costs imposed under a Part
    D plan, including:
    Reduction to the deductible when the deductible is greater than the
    maximum deductible amounts for partial subsidy eligible individuals (See
    Annual Call Letter https://www.cms.gov/Medicare/Health-
    Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2018.pdf)
    • 25% to 100% subsidy of the monthly premium for basic prescription drug
    coverage up to the regional low-income premium subsidy amount;
    Reduction to 15% coinsurance per prescription for covered Part D drugs,
    up to the annual out-of-pocket threshold, and copayments of not more
    than the maximum copayments for Partial subsidy eligible individuals
    above the annual out-of-pocket threshold (See Annual Call Letter
    https://www.cms.gov/Medicare/Health-
    Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2018.pdf);
    • Elimination of the coverage gap; and,
    • Waiver of late enrollment penalty (LEP).
     
    TwoCents, Mar 11, 2019
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