Benefits Information

Member ID: 90803052300

Medicare ID: 1ER0XN9RY11
Plan: 19DMC078
Group number: IH2802031AC

Medicare Part D coverage stages

Throughout the year, your coverage may change depending upon which
stage you are in. To better understand what costs you may incur, we’ve
outlined each stage for you with updated 2019 information.

You are currently in the Coverage gap stage

! Deductible

! Initial coverage

" Coverage gap

Catastrophic
coverage

Learn more about current stage

Coverage gap
During the "coverage gap" stage you may be required to pay more than
you did in the initial coverage stage for your drugs. Once you reach your
coverage gap limit, you will enter into the "catastrophic coverage" stage in
which you will only need to pay a small coinsurance or copayment for
covered prescription Part D drugs for the remainder of the year. Your plan
 may provide additional coverage through the coverage gap. If your plan
provides additional coverage through the coverage gap, you will continue
to pay the same copay or coinsurance as you did in the initial coverage
stage for all or some of your covered drugs.

Use the graph below to keep track of your out-of-pocket spending so

you'll know how close you are to reaching the catastrophic coverage
stage.

Coverage gap as of April 06, 2019

$2,706.02
Coverage gap ends: $5,100.00

Out-of-pocket spending
What you pay when you fill or refill a prescription for a covered Part D
drug. (This includes payments for your drugs, if any, that are made by
family or friends). Payments made for your drugs by any of the following
programs or organizations: "Extra Help" from Medicare; Medicare's
Coverage Gap Discount Program; Indian Health Service; AIDS drug
assistance programs; most charities; and most State Pharmaceutical
Assistance Programs (SPAPs).

$2,393.98 left until the Catastrophic Coverage stage

View claims history ›

2019 Coverage phases for Medicare Part D

Deductible

Starts
On your first day of
coverage

Ends
When you’ve reached
your deductible limit of
$250.00

Initial coverage

Starts
After you’ve reached
your deductible limit of
$250.00

Ends
When your total drug
costs reach $3,820.00

Current phase

Coverage gap

Starts
After your total drug
costs reach $3,820.00

Ends
When your out-of-pocket
costs reach $5,100.00
 Catastrophic
coverage

Starts
After your out-of-pocket
costs reach $5,100.00

Ends
On last calendar day of
the year

Save a trip to the pharmacy and send

medications right to your home in 90-day
# prescriptions with our home delivery service.
View savings options ›