Deductible phase: The annual amount you pay before your plan starts paying. Your deductible is based on the plan type selected.
Initial coverage phase (ICP) This phase starts after you have met your deductible and continues until you and your plan have spent a total of $4660 in 2023. Your co-pay is based on the formulary tier.
Coverage Gap (donut hole) What you pay in the coverage gap for drugs on your plan’s formulary. The most you pay for each prescription while in the coverage gap is 25%.
Items that count towards the coverage gap:
Items that don’t count towards the coverage gap
Catastrophic coverage phase The catastrophic phase starts when you exit the coverage gap and lasts until the end of the calendar year
Many of your Henry Ford pharmacies can bill your prescriptions as a medical benefit through Medicare Part B and your qualified supplemental insurance. Eligibility to bill Medicare Part B is dependent on your medical condition and medication.
You must meet the following criteria to qualify and have active coverage through Medicare Part B or Part C Criteria for Transplant Medication:
Criteria for Nebulizer Medication:
Criteria for Insulin:
Criteria Oncology Medication:
Other Important Information:
coinsurance unless you are insured by a supplement plan.
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