Heres the way I will explain this : $2000 divided by 12 is $166 per month and add back your premium (if there is one) LOL Seriously, is anyone going to try to explain how these drug plans work, really? This can't be explained clearly and succinctly. I defy anyone to try explaining this to someone else, especially Suzie Senior.
Heres the way I will explain this : $2000 divided by 12 is $166 per month and add back your premium (if there is one) LOL Seriously, is anyone going to try to explain how these drug plans work, really? This can't be explained clearly and succinctly. I defy anyone to try explaining this to someone else, especially Suzie Senior.
It can be explained clearly. Agents have a choice to make. Throw your hands up and not help your clients understand it or let someone else explain it to them and take your business. Make a chart or a visual with examples. Even if they all don't get it, you're doing the best you can for you clients.
It's really not that difficult if you take the time.
To those who think this is too complicated to be understood … it’s not. It’s a “greater of” methodology.
There is a standard benefit design. Deductible is $590, then 25% coinsurance. No cost when the enrollee’s actual OOP reaches $2k.
The enrollee has XYZ plan. It may or may not be the same as the standard benefit design.
When the enrollee fills a script, they pay according to their plan’s benefit design. The government also looks to see how the drug WOULD have been covered in the crappiest plan (standard design).
The higher out of pocket outcome is the one that accumulates to the $2k. It doesn’t matter what the enrollee actually paid out of their own pocket.
