Optima Health Creditable Benefit Plans
Medicare beneficiaries can receive subsidized prescription drug coverage through the Medicare Part D program.
Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period.
Beneficiaries who have other sources of drug coverage - through a current or former employer or union, for example - may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the Medicare drug benefit (and therefore considered "creditable coverage"), then the beneficiary can continue to get the high quality care they have now as well as avoid higher payments if they sign up later for the Medicare drug benefit.
Plans deemed creditable for Optima Health for deferment of Part D coverage
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Three Tier Copay Plans |
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Tier 1 Copay |
Tier 2 Copay |
Tier 3 Copay |
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$10 |
$20 |
$30 |
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$10 |
$20 |
$35 |
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$10 |
$20 |
$40 |
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$10 |
$20 |
$50 |
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$10 |
$25 |
$40 |
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$10 |
$25 |
$50 |
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$10 |
$30 |
$50 |
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$10 |
$30 |
$60 |
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$10 |
$35 |
$70 |
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$15 |
$25 |
$35 |
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$15 |
$25 |
$40 |
|
$15 |
$30 |
$45 |
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$15 |
$30 |
$60 |
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$15 |
$35 |
$50 |
|
$20 |
$30 |
$40 |
| Four Tier Copay Plans |
| Tier 1 Copay |
Tier 2 Copay |
Tier 3 Copay |
Tier 4 Copay |
| $10 |
$20 |
$40 |
$75 |
| $10 |
$30 |
$50 |
$75 |
| $10 |
$20 |
$40 |
$80 |
| $10 |
$30 |
$50 |
$80 |
| $10 |
$20 |
$50(1) (3) |
$75(2) (3) |
| $10 |
$30 |
$50(1) (3) |
$75(2) (3) |
| (1) Tier Three: Greater of $50 copay or 20% Coinsurance limited to $250 Per Script Per Month |
| (2) Tier Four: Greater of $75 copay or 20% Coinsurance limited to $250 Per Script Per Month |
| (3) $3,000 Annual Out of Pocket Maximum for Tier 3 and 4 Combined |
| Copay Plans with Deductibles |
| Tier 1 Copay |
Tier 2 Copay |
Tier 3 Copay |
Tier 4 Copay |
Deductible |
| $10 |
$20 |
$40 |
na |
$50 |
| $10 |
$30 |
$50 |
na |
$50 |
| $10 |
$30 |
$50 |
na |
$75 |
| $10 |
$30 |
$50 |
na |
$100 |
| $10 |
$30 |
$50 |
na |
$150 |
| $10 |
$30 |
$50 |
$75 |
$50 |
| $10 |
$30 |
$50 |
$75 |
$150 |
| $10 |
$30 |
$50 |
$100 |
$75 |
| $10 |
$30 |
$50 |
$100 |
$150 |
| $10 |
$30 |
$50(1) (3) |
$75(2) (3) |
$50 (3) |
| $10 |
$30 |
$50(1) (3) |
$75(2) (3) |
$75 (3) |
| $10 |
$30 |
$50(1) (3) |
$75(2) (3) |
$100 (3) |
| $10 |
$30 |
$50(1) (3) |
$75(2) (3) |
$150 (3) |
| (1) Tier Three: Greater of $50 copay or 20% Coinsurance limited to $250 Per Script Per Month |
| (2) Tier Four: Greater of $75 copay or 20% Coinsurance limited to $250 Per Script Per Month |
| (3) $3,000 Annual Out of Pocket Maximum for Tier 3 and 4 Combined |
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| Miscellaneous Plans Descriptions |
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| 1) $10/$30/$50 Copay with $5,000 Annual Maximum Benefit |
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| 2) $50 Annual Deductible, then |
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| $10 / 30% / 50% Copay |
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| with Percent copays limited to $20 minimum and $100 Maximum |
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| 3) $50 Annual Deductible, then 20% Coinsurance |
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| 4) $5 Copay In-Network for Formulary Generic & Brand (when no generic is available). |
| Everything Else $10 copay plus 30% Coinsurance |
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Conditionally Creditable Benefit Plans
The below Health Savings Accounts (HSA) Plans are only deemed creditable for deferment of Part D coverage if the plan is not secondary to other coverage. In particular, if the HSA plan is secondary to Medicare Parts A or B, then the HSA is NOT Creditable.
| H.S.A Plans |
| Deductible |
Coinsurance |
OOP Max |
| $2,000 |
0% |
$2,000 |
| $2,200 |
0% |
$2,200 |
| $2,300 |
0% |
$2,300 |
| $2,000 |
20% |
$4,000 |
| $2,200 |
20% |
$4,000 |
| $2,300 |
20% |
$4,000 |
| $2,500 |
0% |
$2,500 |
| $2,500 |
20% |
$4,500 |
| $3,000 |
0% |
$3,000 |
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Non-Creditable Benefit Plans
Plans deemed creditable for deferment of Part D coverage
| Non-Creditable Benefit Plan Descriptions |
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| 1) $50 annual deductible, $12/$24 Copay with $1,500 Annual Maximum Benefit. |
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| 2) H.S.A. plan with $3,000 deductible, 20% Coinsurance and $5,000 OOP Max. |
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| 3) 50% Coinsurance with the following OOP member limits RETAIL (M/O doubled): |
| 1st tier: $10 minimum/$100 maximum |
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| 2nd tier: $20 minimum/$100 maximum |
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| 3rd tier: $35 minimum/$100 maximum |
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| 4) $15/$30/ Greater of $50 or 50% but Max of $300 - Generic Only Plan. |
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More Information
Need more information about Part D and creditable plans? Visit the Centers for Medicaid and Medicare Web site.
Questions
Have questions or are unable to determine if your plan meets the requirements? Contact us.
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