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Benefit Parameters | 2021 | 2020 |
Deductible | $445.00 | $435.00 |
Initial Coverage Limit | $4,130.00 | $4,020.00 |
Out-of-Pocket Threshold | $6,550.00 | $6,350.00 |
Total Covered Drug Spending at OOP Threshold | $9,313.75 | $9,038.75 |
Minimum Cost-Sharing in Catastrophic Coverage | $3.70 / $9.20 | $3.60 / $8.95 |
Extra Help Copayments | 2021 | 2020 |
Institutionalized | $0 | $0 |
Receiving Home and Community-Based Services (under waiver only) |
$0 | $0 |
Up to or at 100% Federal Poverty Level (FPL) | $1.30 / $4.00 | $1.30 / $3.90 |
Full Extra Help | $3.70 / $9.20 | $3.60 / $8.95 |
Partial Extra Help (Deductible / Cost-Sharing) | $92 / 15% | $89 / 15% |
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