Covered California Bronze 60 HSA Rx Benefits
The Covered California Bronze 60 HSA plan does not include a separate Rx deductible. Rather, the medical deductible applies to all Rx regardless of tier. So for coverage to kick in, the plan deductible must first be met. Once the deductible is met, the member will pay 0% on covered prescriptions.
| You pay… | |
| Individual | $7,200 deductible for medical and drugs |
| Family | $14,400 deductible for medical and drugs |
| Tier 1 (generic) Rx Copay | No charge after deductible |
| Tier 2 (preferred brand) Rx Copay | No charge after deductible |
| Tier 3 (non-preferred brand) Rx Copay | No charge after deductible |
| Tier 4 (specialty) Rx Copay | No charge after deductible |
It is good to know that there is a cap if you experience an expensive year. If you take expensive medications or experience a year in which you need a lot of prescriptions, the most you will pay for anything (prescription drug costs included) in a year, is the out-of-pocket maximum which is the same as the deductible on this plan (see chart above).
Example 1:
You’re prescribed a Tier 1 (generic) drug by your doctor. A 30 day supply costs $35. You will pay $35 since the drug cost is less than the deductible.
Example 2:
You’re prescribed a Tier 4 (specialty) drug that costs $10,000. You will pay $7,200 of the cost to cover the deductible. Your total cost would be $7,200.
Later that year you’re prescribed another Tier 4 (specialty) drug by your Doctor. The cost of this drug is also $10,000. Since you had previously met your deductible (and out-of-pocket maximum), the cost for it will be $0.
Tip: Consult your insurance carrier and doctor before filling a prescription to understand costs and required authorization procedures and to see if there are options for less expensive medications.