just-a-client
Expert
- 35
Chiming in here, as a non-agent.So what determines if a mapd rx part is enchanced or standard? Is enchanced if you have $ copays and standard if you have % copays ? The enchanced example your using is a $255 deductible plan?
A plan can do things like that, and be an alternative plan,but not necessarily enhanced alternative.
These plan designs can include things like if a plan charges less than full deductible, has non-standard cost-sharing, has coverage in the gap, uses preferred pharmacies with a tiered stucture, has a broader formulary. The "enhanced alternative" plan increases the plans actuarial value above the Defined Standard benefit. The other alternative plans are actuarially equivalent.
This page explains all the different alternative plans. Quite a few! And it gets damned complicated. The page also explains how some plans are fully LIS and others are not. (So, Wellcare Classic has worse benefits like a full deductible and a higher premium than Value Script, so you'd wonder why anyone would pick it, but it's designed for dual eligibles and has $0 premium with LIS, along with reduced cost sharing if LIS-eligible.)
There are fewer LIS plans than there used to be, I guess because more plans are using enhanced alternative designs.
Perhaps with all alternative plans, the progress towards Max OOP max is the way Jim explained it above, even if the plan isn't "enhanced."
[EXTERNAL LINK] - What are the Medicare Part D abbreviations: EA BA DS AE in the plan benefit type?