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 $9,100, per individual.
|Individual||$9,100 maximum out-of-pocket, per individual, for medical and drugs|
|Family||$18,200 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 $9,100 maximum out-of-pocket applies to all Rx regardless of tier. In order for coverage to kick in the $9,100 individual maximum out-of-pocket must first be met.
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 $9,100 out-of-pocket maximum.
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.
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 $4,100 (the remaining balance of your out-of-pocket max) since you had previously paid $5,000 toward your maximum out-of-pocket.
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