Will a $0 deductible Rx Plan count $590 toward the $2,000 limit?

[Jim Wright]

Don't be so sure that every MAPD plan that has a less than $590 deductible is considered enhanced. I've already spoken to one carrier that told me specifically that their lower drug deductible plans are NOT considered enhanced for that calculation.

 

[wehotex]

Don't be so sure that every MAPD plan that has a less than $590 deductible is considered enhanced. I've already spoken to one carrier that told me specifically that their lower drug deductible plans are NOT considered enhanced for that calculation.

Is it always the case that an MAPD with $0 premium and $0 deductible is an enhanced plan? Where is the CMS guidance on this?

 

[Jim Wright]

Is it always the case that an MAPD with $0 premium and $0 deductible is an enhanced plan? Where is the CMS guidance on this?

It is not always the case. I'm still doing some digging but I think the carrier has to actually file it as an enhanced drug plan. When I figure it out, I'll post it here.

 

[Special Agent]

Is it always the case that an MAPD with $0 premium and $0 deductible is an enhanced plan? Where is the CMS guidance on this?

anything that is an improvement or " enhancement" over the standard model of 590 deductible and 25% coinsurance is an enhanced plan

 

[MedicareWAA]

It is not always the case. I'm still doing some digging but I think the carrier has to actually file it as an enhanced drug plan. When I figure it out, I'll post it here.

It doesn’t matter so long as the drug someone takes is covered better on the plan than how it would be covered under the standard design. The system is simply running the claim through two designs (standard vs the member’s plan) and applying the higher OOP against the max.

 

[Jim Wright]

anything that is an improvement or " enhancement" over the standard model of 590 deductible and 25% coinsurance is an enhanced plan

Would you mind showing proof? I have not seen that anywhere. CMS's definition is vague and carriers have told me specifically that not all of their plans are enhanced.

 

[Special Agent]

Would you mind showing proof? I have not seen that anywhere. CMS's definition is vague and carriers have told me specifically that not all of their plans are enhanced.

don't think there is even any Standard Model plans available because those would have a Defined Benefit structure of 590 deductible 25% co insurance and a premium of 34.70 this is the benchmark premium that plans are not allowed to have more than a 6% increase in year over year premium increase

pretty much every pdp and mapd is going to be an " enhanced plan" What matters is who pays the 590 standard deductible ( which always go towards the troop ) and how much does insurance company contribute to the 25% cost of the drug each month.If it is a fixed copay of 47 vs a percentage then usually the insurance company going to be more contributing more especially for the more expensive drugs.

What to Know About Medicare Part D Premiums | KFF

Changes to the Medicare Part D benefit in the Inflation Reduction Act will mean lower out-of-pocket costs for Part D enrollees but higher costs for Part D plans overall, leading to concerns about possible premium increases. These FAQs provide context for understanding Part D premiums in 2025 and...

www.kff.org

 

[LostDollar]

Caveat, not an agent.

I do not understand all of this enhanced stuff and I don't think it applies to buying decisions I personally have to make.

However, for those of you discussing this concern, the landscape file linked in another thread tells whether the plans, MA or PDP, are basic or enhanced. There is no discussion of rules for the classification, but the classifications for each plan are shown.

 

[LostDollar]

don't think there is even any Standard Model plans available because those would have a Defined Benefit structure of 590 deductible 25% co insurance and a premium of 34.70 this is the benchmark premium that plans are not allowed to have more than a 6% increase in year over year premium increase

pretty much every pdp and mapd is going to be an " enhanced plan" What matters is who pays the 590 standard deductible ( which always go towards the troop ) and how much does insurance company contribute to the 25% cost of the drug each month.If it is a fixed copay of 47 vs a percentage then usually the insurance company going to be more contributing more especially for the more expensive drugs.

What to Know About Medicare Part D Premiums | KFF

Changes to the Medicare Part D benefit in the Inflation Reduction Act will mean lower out-of-pocket costs for Part D enrollees but higher costs for Part D plans overall, leading to concerns about possible premium increases. These FAQs provide context for understanding Part D premiums in 2025 and...

www.kff.org

Not an agent.
If that classification is important, I would suggest being careful with that assumption.

In the landscape file, in the PDP section for Kansas, there are a number of plans described as basic rather than enhanced.

 

[Jim Wright]

Caveat, not an agent.

I do not understand all of this enhanced stuff and I don't think it applies to buying decisions I personally have to make.

However, for those of you discussing this concern, the landscape file linked in another thread tells whether the plans, MA or PDP, are basic or enhanced. There is no discussion of rules for the classification, but the classifications for each plan are shown.

Thanks LD! Nailed it.

That's what I've been looking for!