An exciting change has been made to your coverage – here’s what you need to know.

Starting January 1, 2025, there is no longer a “Coverage Gap,” also called the “Donut Hole” Phase, in your prescription drug plan. This means that once you reach the end of your Initial Coverage Phase, you’ll move directly to the Catastrophic Coverage Phase, where you pay nothing for your covered prescriptions

Initial Deductible
During the Initial Deductible Phase, you pay the full amount (100%) of the cost for your prescriptions until the total amount you pay for your drugs reaches your deductible amount. This phase is the first phase of your prescription drug plan*.

*Most of our plans do not have a deductible. The Health Alliance Medicare POS Enrich Rx plan does have a pharmacy deductible.

Initial Coverage

During the Initial Coverage Phase, your plan starts helping you pay for your prescriptions. You only pay your copay/coinsurance amount, and your plan pays the rest. You’re in this phase until the amount you pay reaches $2,000. This phase is the second phase of your prescription drug plan and once that amount is reached, you enter into the third phase – the Catastrophic Coverage phase.

Catastrophic Coverage

In the Catastrophic Coverage Phase, you pay $0 for your drugs for the rest of the plan year, as long as those drugs are on your plan's formulary and you get them at an in-network pharmacy. You enter this phase once your total out-of-pocket drug costs for the year reach $2,000. This phase is now the third phase of your prescription drug plan.