Covered California Bronze 60 Rx Benefits
| You pay… | |
| Individual | $500 Rx deductible |
| Family | $1,000 Rx deductible |
| Tier 1 ( most generics) Rx Copay | $17 prescription (retail). After drug deductible. |
| Tier 2 (preferred brand) Rx Copay | 40% coinsurance up to $500 after drug deductible. |
| Tier 3 (non-preferred brand) Rx Copay | 40% coinsurance up to $500 after drug deductible. |
| Tier 4 (specialty) Rx Copay | 40% coinsurance up to $500 after drug deductible. |
The Rx deductible works similarly to any deductible. In order for your coverage to kick in, you must first pay for services up to the amount of the deductible. Once the deductible is met, your health plan benefits will kick in. However, it’s important to remember that paying into you Rx deductible does not count toward your plans medical deductible and vice versa. They are always separate.
It is comforting to know that if you take multiple medications, expensive medications or you experience a year in which you need a lot of prescriptions the most you will pay for anything (prescription drug costs included) in a year, is the out-of-pocket maximum which is $9,100 for an individual or $18,200 for a family on the Bronze plan.
Coverage is generally calculated per script or each time the prescription is filled for up to (but not exceeding) a 30 day supply of the drug. For a 1-30 day supply the “per script” cost would be met once. For a 31-60 day supply the “per script” cost would have to be met twice. For 61-90, three times, etc.
Example 1:
You’re prescribed a Tier 1(generic) drug by your doctor. A 30 day supply costs $100. You will pay the full $100 since the drug cost is less than the deductible.
Example 2:
You’re prescribed a Tier 4(specialty) drug by your Doctor. A 30 day supply costs $1,200. You will pay the $500 Rx deductible and the $500 maximum per script totaling $1,000. If the same prescription needs to be refilled after a month, you will pay $500 per 30 day supply since you already met your plan’s Rx deductible of $500.