How Does Amerigroup Cover LOWER Coverage Gap Threshold?

[wehotex]

Every MA plan that I've ever seen covers minimum ($2,850 worth this year) or MORE. Until this plan, I had never seen one that offers less. I brought it up to the clueless Amerigroup broker rep, but he has never gotten back to me on it.

Summary of Benefits reads:

Coverage Gap
After your total yearly drug costs reach $2,300, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.

 

[benefits365]

Every MA plan that I've ever seen covers minimum ($2,850 worth this year) or MORE. Until this plan, I had never seen one that offers less. I brought it up to the clueless Amerigroup broker rep, but he has never gotten back to me on it.

Summary of Benefits reads:

Coverage Gap
After your total yearly drug costs reach $2,300, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.

The answer has to do with actuarial value. I'm not an actuary, so I'm the wrong guy to explain a mathematical answer to this question. Basically, though, as long as the health plan covers a mathematically equivalent portion of a consumers cost, they can make alterations to the standard part d coverage gap benchmark points.

Ice seen it a few times in hotly contested ma areas like Miami Dade county, but it's definitely rare.