Which Drugs Does Aetna Medicare Part D Cover?
Each Aetna prescription drug plan has a different list of covered medications based on your area of coverage. This is sometimes called a “formulary.” Typically, your formulary will place different drugs in different tiers, according to cost. Lower-tier drugs generally cost less, and higher-tier drugs generally cost more.
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Aetna Medicare Rx Coverage Phases
Prescription drugs on Medicare Part D are covered in a series of phases each year. Depending on your plan, the following coverage phases may apply:
If your Aetna Medicare Part D plan includes a deductible, this is the first phase of your coverage. Your deductible is how much you need to pay before your plan will start paying for medications. Keep in mind, your deductible may change each year depending on your plan.
Initial Coverage Phase
Once your deductible is met, your initial coverage phase begins. What this means is that you’ll either pay a small copay (a fixed dollar amount) or coinsurance (a specific percentage of the remaining cost of medications after your deductible). Your plan will cover the rest of your medications. Similar to your deductible, your copay and coinsurance amounts may change from year to year.
Coverage Gap Phase
If you reach the insurance limit on your Aetna Medicare Part D drug plan, you’ll enter a coverage gap, sometimes called the Medicare “donut hole.” Depending on your plan, this may mean that you’ll have to pay a bigger portion of the cost of your medications. There are varying levels of coverage in the gap depending on your plan, so talk to a licensed agent to find out what to expect.
Catasctrophic Coverage Phase
If your prescription medication charges meet the coverage gap limit, you’ll enter what’s called the catastrophic coverage phase. What this means is you’ll end up paying less for copayments or coinsurance than you did during your initial coverage phase or during your coverage gap. These lower rates will last until the end of your plan year, at which time your plan will re-enter the deductible phase (if your plan includes a deductible) or the initial coverage phase (if your plan doesn’t have a deductible).
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drug coverage phases?
Am I Eligible for Medicare Part D?
In order to qualify for an Aetna Medicare Part D plan, all you have to do is:
- Be eligible for Medicare Part A, Part B, or both
- Live in an area where Aetna offers Medicare Part D plans