Does Partial Extra Help offer Gap coverage?

[wehotex]

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?

 

[TwoCents]

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?

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).