2017 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, in order for coverage to kick in, the plan deductible ($4,500 for individuals, $9,000 for families) must first be met. Once the plan deductible is met, the member will have a copay of 40% of the cost of the prescription
|Individual||$4,500 deductible for medical and drugs|
|Family||$9,000 deductible for medical and drugs|
|Tier 1 (generic) Rx Copay||40% after deductible|
|Tier 2 (preferred brand) Rx Copay||40% after deductible|
|Tier 3 (non-preferred brand) Rx Copay||40% after deductible|
|Tier 4 (specialty) Rx Copay||40% after deductible|
It is comforting to know that if you take multiple medications, expensive medications or you 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 $6,500 for an individual or $13,000 for a family on the Bronze plan.
You’re prescribed a Tier 1(generic) drug by your Doctor that costs $100. You will pay the full $100 since the drug cost is less than the deductible.
You’re prescribed a Tier 4 (specialty) drug that costs $5,000. You will pay $4,500 of the cost to cover the deductible and 40% of the remaining balance. Your total cost would be $4,700.
Later that that year you’re prescribed another Tier 4 (specialty) drug by your Doctor. The cost of this drug is also $5,000. Since you had previously met your deductible, this time you will only pay 40% of the total cost or $2,000. However, the Bronze 60 HSA plan has a Maximum Out-of-Pocket of $6,500. Therefore your total cost for the second prescription will be $1,800.