Snapshot, Pulaski County, Kentucky 2019-2020 | Page 46

Explanation of Benefits HMO - Health Maintenance Organization PPO - Preferred Provider Organization PDP - Prescription Drug Plan SNP - Special Needs Plan POS - Point of Service PFFS - Private Fee For Service Monthly Consolidated Premium (Includes Part C + D) Your premium may be lower depending on your eligibility for medical assistance. Call your provider for details. Part D Total Premium: The Part D Total Premium is the sum of the Ba- sic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to “buy down” the drug premium for Medicare Advantage; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums. GAP In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA “donut hole”) Once you reach the cover- age gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 37% on generic drugs unless your plan offers additional coverage. Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services. NOT Part D - prescription drugs. N/A is defined as Not Applicable Source: CMS. Data as of September 5, 2018. Star Rating as of October 10, 2018. For More Information on Ratings Please See the CMS Tech Notes. Plans are subject to change as contracts are finalized. Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2019, enhanced alterna- tive may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Benefit Type (EA) Enhanced Alternative may offer additional gap coverage which is calculated as the percentage of generic formulary products with coverage above standard generic coverage gap cost-sharing benefit and/or the percentage of brand formulary products covered in addi- tion to the coverage gap discount for applicable drugs. (DS) Defined Standard Benefit (BA) Basic Alternative (AE) Actuarially Equivalent Standard Crawford & Hatfield Lake Cumberland Insurance Services 290 McKee Rd • 606-679-6904 [email protected] Monday-Friday 9:00-5:00 Proudly serving the Lake Cumberland Area Since 2005 L aura C rawford C oomer 46 2019-2020 Pulaski County snapshot l a special publication of the Commonwealth Journal