2017 Covered California Minimum Coverage Plan Rx Benefits

One of the lowest cost health plans, the Minimum Coverage plan does not have an Rx drug deductible. Medical expenses and prescription drugs costs apply toward the maximum out-of-pocket of $7,150, per individual.

Minimum Coverage Plan Rx Benefits
  You pay…
Individual $7,150 maximum out-of-pocket, per individual, for medical and drugs
Family $7,150 maximum out-of-pocket, per individual, for medical and drugs
Tier 1 ( most generics) Rx Copay 100% until maximum out-of-pocket is met
Tier 2 (preferred brand) Rx Copay 100% until maximum out-of-pocket is met
Tier 3 (non-preferred brand) Rx Copay 100% until maximum out-of-pocket is met
Tier 4 (specialty) Rx Copay 100% until maximum out-of-pocket is met

No Rx Deductible

The Covered California Minimum Coverage plan does not include a deductible but the member will need to pay the maximum out-of-pocket before coverage applies. The $7,150 maximum out-of-pocket applies to all Rx regardless of tier. In order for coverage to kick in the $7,150 individual maximum out-of-pocket must first be met.

Rx Maximum

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 $7,150 out-of-pocket maximum.

Example 1

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 maximum out-of-pocket.

Example 2:

You’re prescribed a Tier 4 (specialty) drug that costs $5,000. You will pay the full $5,000 since the drug cost is less than the maximum out-of-pocket.

Later that that year you’re prescribed another Tier 4 (specialty) drug by your Doctor. The cost of this drug is also $5,000. This time you will only pay $2,850 (the remaining balance of your out-of-pocket max) since you had previously paid $5,000 toward your maximum out-of-pocket.