About Premiums and Deductibles
Premiums
A premium is a monthly charge you pay to participate in an insurance plan, like a Medicare Prescription Drug Plan. You will either receive monthly invoices, direct billing, or if you choose, you may elect to have your premiums deducted from your Social Security check each month. Our Denver Health premium for both plans is $32.80 in 2011. Individuals with full Medicaid and those who qualify for 'Extra Help' will pay $0 or a reduced amount.
Annual Deductible
A deductible is the amount that you must pay before the plan sponsor begins to pick up part of the costs. The deductible for the standard plan is $310. In 2011, Medicare Choice members have $0 deductible and Medicare Select members have a $310 deductible.
Co-Insurance
After meeting the annual deductible, the standard Medicare Prescription drug plan enters an Initial Coverage Limit stage. During this stage, Medicare Select plan will pay for 75% of your prescription expense and member will pay the other 25% until the total yearly drug cost reaches $2,840. Medicare Choice members pay $0, or $1.10 to $2.50 for generic drugs and $3.30 to $6.30 for brand drugs.
Co-payment
Some plans may use a co-payment instead of co-insurance. In this case, the co-insurance will be the same based on the type of drug – generics generally have the lowest flat-dollar co-payment. Other categories may include preferred brands and/or non-preferred brands. Many plans may also cover biologics or specialty medications at either a co-payment or through co-insurance.