Health Net Value Orange Option 2 PDP for New Hampshire Seniors
|Initial Coverage Limit:||$2,930.00|
|Pharmacy Mail Order:||Yes|
|Gap Coverage:||Few Generics|
|Low Income Subsidy:||No|
|PDP ID No:||S5678-013|
|Approved by CMS for:||NH Residents|
|Rx Plan Type:||Regional|
|Members in Region:||503|
2013 Medicare Prescription Drug Plan Overview
NH Health Net Value Orange Option 2 (PDP) is a Medicare prescription drug plan underwritten by Health Net for eligible residents of New Hampshire. The plan is approved by CMS for drug formulary 00012050, which has 3995 FDA approved medications. The monthly premium is $67.10 ($805.20 for a full 12 months) and the pharmacy deductible is $0.00 per year. That means you receive prescription coverage assistance on day one (first dollar coverage).
New Hampshire seniors, be aware that a few different circumstances may decrease or increase your actual premium. Specifically, if you qualify for Extra Help (full or partial), your premium will decrease. On the other hand, if you have a premium penalty, your premium will be slightly more.
Health Net Value Orange Option 2 Initial Coverage Phase
The Initial Coverage Phase (ICP) is your plan’s cost-sharing phase. During the ICP both you and your insurance provider share the cost of your prescription medications. This plan has no deductible so your initial coverage phase begins immediately.
Each medication is put into a tier within the plan’s formulary. This is simply a way for the insurer to manage cost-sharing. It’s important to note that every plan can put medications on any tier they deem suitable. This is not standardized, because it is based on cost and the various risk models used by the insurers.
The tiered prescription cost sharing (e.g., pharmacy co-pay) in New Hampshire with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$0.00||1680 Preferred Generics|
|2||$32.00||648 Non-Preferred Generics|
|3||$64.00||702 Preferred Brand Drugs|
|4||33%||674 Non-Preferred Brand Drugs|
|5||33%||291 Specialty Drugs|
The 2012 Initial Coverage Limit with Health Net Value Orange Option 2 is $2,930.00. This drug plan doesn't qualify for a no cost LIS premium.
Coverage Gap Phase
The Coverage Gap, also known as the Donut Hole is the phase of your Part D plan where you must pay all of your medication costs. Healthcare Reform offers some additional assistance. For 2012 your insurance carrier will pay 7% of your generic drug prescription costs for you while you are in the donut hole. Likewise, the brand-name drug pharmaceutical companies cover half (50%) of your brand-name drug prescription costs. These subsidies count toward your True Out of Pocket (TrOOP) costs.
Some Medicare Part D plans provide additional Coverage Gap assistance that covers you above and beyond the discounts mandated by the Healthcare Reform Act. It’s important to note that if you have prescriptions that are not covered under your plan’s Gap Coverage, you will still get the generic and brand name drug discounts listed above, even if the plan itself does not offer gap coverage.
Here's how the carrier defines the 'donut hole' gap coverage for this policy: Less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.50. Use our free New Hampshire donut hole calculator to estimate out-of-pocket expenses for your precscription drugs with this policy.
The number of Medicare recipients using the Health Net Value Orange Option 2 plan nationally is 34,104. In your area (CMS PDP region 1) there are a reported 503 seniors on this plan. That's based on the previous year's reporting information.
More Information About Health Net
Health Net is among the USA's largest publicly traded health insurers. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs programs. Health Net’s behavioral health services subsidiary, MHN, provides behavioral health, substance abuse and employee assistance programs (EAPs) to approximately 7.3 million individuals in various states, including the company’s own health plan members. The company’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
The summary (overall) rating for this Health Net plan is 3.0 out of 5 based on reviews from 503 user ratings from the previous year. For more information about the review process, visit http://cms.gov.