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(after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.
|Initial Coverage Limit -
Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold).
|Total Covered Part D Drug Spending including the Coverage Gap -
Catastrophic Coverage starts after this point.
|Out-of-Pocket Threshold -
This is the Total Out-of-Pocket Costs including the Donut Hole.
** The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2014, beneficiaries would be charged $2.55 for those generic or preferred multisource drugs with a retail price under $51 and 5% for those with a retail price greater than $51. As to Brand drugs, beneficiaries would pay $6.35 for those drugs with a retail price under $127 and 5% for those with a retail price over $127.
|Brand Name Drugs||$6.50||$6.60**||$6.35**||$6.60**|
**The Catastrophic Coverage is the greatest of 5% or the values shown in the chart above.
View a complete list of Medicare Prescription Plans in Indiana (2015) updated 10/13/14)