Plan Designs
A Plan to Fit Your Needs
Medicare prescription drug coverage is available to all people with Medicare.
Whether you are comfortable with a standard Medicare Part D plan or prefer
expanded coverage, DeanCare Rx plans offer options and flexibility to meet
your needs.| 2010 Plan Basics | DeanCare Rx Classic | DeanCare Rx Value Plan | DeanCare Rx Enhanced |
|
Your monthly premium is Your annual deductible is |
$68.30 $310 |
$42.60 $0 |
$92.90 $0 |
| After your annual deductible is paid | |||
|
Your network copay for Tier 1 Drugs is Your network copay for Tier 2 Drugs is Your network copay for Tier 3 Drugs is Your network co-insurance for Tier 4 Drugs is |
$4 for a 30-day supply $8 for a 90-day supply $47 for a 30-day supply $94 for a 90-day supply 25% 25% Not Applicable |
$6 for a 30-day supply $12 for a 90-day supply $34 for a 30-day supply $68 for a 90-day supply $84 for a 30-day supply $168 for a 90-day supply 33% for a 30-day supply |
$5 for a 30-day supply $10 for a 90-day supply $37 for a 30-day supply $74 for a 90-day supply $72 for a 30-day supply $144 for a 90-day supply 33% for a 30-day supply |
|
After the total drug costs (paid by both you and your plan) reaches |
$2,830 | $2,520 | $2,520 |
|
For Tier 1 drugs You Pay : All other drugs
|
You pay 100% You pay 100% |
You pay 100% You pay 100% |
Retail Pharmacy Tier 1 $5 for a 30-day supply
$10 for a 90-day supply Longterm Care Pharmacy Tier 1 - $5 for a 31-day supply Mail-Order Tier 1 - $10 for a 90-day supply You pay 100% |
| After your out-of-pocket drug costs reaches | $4,550 | $4,550 | $4,550 |
| For generic (including brand drugs treated as generic) Your cost for all other drugs is |
$2.50 $6.30 or 5% coinsurance |
$2.50 $6.30 or 5% coinsurance |
$2.50 $6.30 or 5% coinsurance |
| 2009 Plan Basics | DeanCare Rx Classic | DeanCare Rx Value Plan | DeanCare Rx Enhanced |
|
Your monthly premium is Your annual deductible is |
$64.00 $295 |
$39.90 $0 |
$93.70 $0 |
| After your annual deductible is paid | |||
Your network copay for Tier 1 Drugs is
|
$4 for a 30-day supply $8 for a 90-day supply $40 for a 30-day supply $80 for a 90-day supply 25% 25% Not Applicable |
$4 for a 30-day supply $8 for a 90-day supply $28 for a 30-day supply $56 for a 90-day supply $78 for a 30-day supply $156 for a 90-day supply 33% for a 30-day supply |
$3 / 30-day supply $6 for a 90-day supply $35 for a 30-day supply $70 for a 90-day supply $70 for a 30-day supply $140 for a 90-day supply 33% for a 30-day supply |
|
After the total drug costs (paid by both you and your plan) reaches |
$2,700 | $2,470 | $2,510 |
|
For Tier 1 drugs You Pay : All other drugs
|
You pay 100% You pay 100% |
You pay 100% You pay 100% |
Retail Pharmacy Tier 1 $3 for a 30-day supply
$6 for a 90-day supply Longterm Care Pharmacy Tier 1 - $3 for a 31-day supply Mail-Order Tier 1 - $6 for a 90-day supply You pay 100% |
| After your out-of-pocket drug costs reaches | $4,350 | $4,350 | $4,350 |
| For generic (including brand drugs treated as generic) Your cost for all other drugs is |
$2.40 $6.00 or 5% coinsurance |
$2.40 $6.00 or 5% coinsurance |
$2.40 $6.00 or 5% coinsurance |
S5954_WEB10_1010 10/22/2009
