Prescription Drug Coverage with TRAIL
Since Medicare Advantage plans are a type of Medicare plan, the prescription drug coverage provided under the TRAIL Medicare Advantage plan includes Medicare Part D prescription drug coverage. Prescription drug formularies (i.e., list of drugs covered) vary by plan. The TRAIL prescription drug coverage, like a Medicare Part D plan, must follow Medicare rules for which types of drugs are allowed to be covered. For example, many hormone drugs have been determined not safe for individuals over the age of 65. For this reason, Medicare will not cover some drugs in this class. If you are uncertain whether a particular drug will be covered, you should call the health plan in which you are interested in enrolling to inquire.
Part D Coverage Stages
Since the TRAIL prescription drug coverage is a Medicare Part D plan, the member’s cost for prescription drugs under the TRAIL Program must follow the Medicare Part D drug coverage ‘stages.’ There are four drug payment stages: Annual Deductible, Initial Coverage, Coverage Gap and Catastrophic Coverage. Unlike a standard Part D plan in which the retiree is required to pay a percentage of the full retail cost of the drug, State members enrolled in the TRAIL Medicare Advantage Program pay only the plan’s standard copayment through the Initial Coverage and Coverage Gap stages (Coverage Gap is also referred to as the ‘Donut Hole’). Paying only the standard copayment through the Coverage Gap is a valuable benefit for TRAIL members. Once you reach the Catastrophic Coverage stage (i.e., your “true out-of-pocket” costs, also referred to as “TrOOP,” for your prescription drugs during the plan year reaches $5,000), the member will pay either a small copayment or 5% coinsurance that is capped to limit a member's out-of-pocket costs. TRAIL copayments and prescription caps (caps apply once you are in the Catastrophic Coverage stage) are listed in the charts on pages 18 and 19 of the TRAIL Decision Guide