HMSA’s 65C Plus Enhanced Prescription Drug Coverage, ERx, is an optional supplemental
benefit for members of HMSA’s 65C Plus health plan.
With HMSA’s 65C Plus Prescription Drug Coverage, both generic and brand-name prescription
drugs are covered, and out-of-state pharmacies are available.
HMSA’s 65C Plus Prescription Drug Coverage has an open drug formulary, which means
it covers all qualified Medicare prescription drugs. A formulary is a list of prescription
drugs that represent therapies believed to be a necessary part of a quality treatment
program.
ERx Low Income Subsidy 2008 Premiums and Copayments
| Subsidy |
Monthly Premium |
Annual Deductible |
Copayment/
Co-insurance * |
Catastrophic Copayment ** |
| 1 |
$ 131.20 |
$ 0.00 |
$ 2.25 / $ 5.60 |
$ 0.00 / $ 0.00 |
| 2 |
$ 131.20 |
$ 0.00 |
$ 1.05 / $ 3.10 |
$ 0.00 / $ 0.00 |
| 3 |
$ 131.20 |
$ 0.00 |
$ 0.00 / $ 0.00 |
$ 0.00 / $ 0.00 |
| 4 (100%) |
$ 131.20 |
$56.00 |
15% |
$ 2.25 / $ 5.60 |
| 4 (75%) |
$ 137.30 |
$56.00 |
15% |
$ 2.25 / $ 5.60 |
| 4 (50%) |
$143.30 |
$56.00 |
15% |
$ 2.25 / $ 5.60 |
| 4 (25%) |
$149.40 |
$56.00 |
15% |
$ 2.25 / $ 5.60 |
* Copayment amounts for generic and brand drugs, respectively. For example, the
first amount shown ($2.25) is the copayment for a generic drug filled for a member
who is in the Low Income Subsidy Category 1.
** Catastrophic copayment amounts for generic and brand drugs, respectively. For
example, the first amount shown ($0.00) is the copayment for a generic drug filled
for a member who is in the Low Income Subsidy Category 1 and who has reached the
catastrophic coverage phase of their 65C Plus Prescription Drug Coverage.
NOTE: Beneficiaries receiving extra help are responsible for paying the monthly
premium amounts listed above. The monthly premium amounts do not include the premium
for your 65C Plus health plan. You must continue to pay HMSA for your 65C Plus health
plan premium and pay Medicare for your Part B premium.
Beneficiaries may apply for the low income subsidy through the Social Security Administration
or state Medicaid agency.
65C Plus has a contract with the Centers for Medicare & Medicaid Services (CMS),
the government agency that runs the Medicare program. This contract renews each
year. At the end of each year, the contract is reviewed, and either 65C Plus or
CMS can decide to end it. It is possible for our contract to end at some other time
during the year, too. If the contract should end, HMSA will provide advance notice
to all 65C Plus members.