Catastrophic Benefits

(redirected from Catastrophic Benefit)
A 2nd tier of health insurance or health care plan benefits that are ‘activated’ once the benefits have been exhausted from the 1st tier, after which coverage is provided under the catastrophic portion of the policy or plan, in which ‘deductible’ fees must be paid and co-payment requirements met
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The stability in average basic Medicare Part D premiums for enrollees comes despite the fact that Part D costs continue to increase faster than other parts of Medicare, largely driven by high-cost specialty drugs and their effect on spending in the catastrophic benefit phase.
The forecast comes despite the fact that total Part D costs per capita grew by almost 11% last year, an increase that was driven largely by high-cost specialty drags and their effect on spending in the catastrophic benefit phase.
A catastrophic benefit for severe disabilities often can be added as an option;
There [are] no premiums, no gap, a minimum copay, no deductible, and a full catastrophic benefit.
However, after $5,100, Medicare's catastrophic benefit kicks in and the beneficiary then only pays the monthly premium plus a 5% co-pay on drug costs.
Finally, the Senate Republican plan provides an option for the self-employed to obtain a basic catastrophic benefit coverage plan.
These payments are for various health insurance benefits such as inpatient, outpatient, and catastrophic benefit packages provided to PhilHealth members and dependents by the 232 accredited health care institutions and 1,454 accredited health care professionals in the region.
Chart 1--Medicare Part D Basic Benefit Costs Coverage Drug Costs Beneficiary Pays Deductible $250 $0-$250 100% Initial Benefit $251-$2,250 25% Coverage Gap $2,251-$5,100 100% Catastrophic Benefit Over $5,100 5% Coverage Medicare Beneficiary's Part D Pays Cumulative Total Cost Deductible $250 Nothing $250 Initial Benefit 75% $750 Coverage Gap Nothing $3,600 Catastrophic Benefit 95% $3,600 plus 5% above $5,100 Chart 2--2005 Health and Human Services (HHS) Poverty Guidelines Persons 48 States Alaska Hawaii in Family and D.
The study's findings have important implications for all of the various prescription drug legislation pending in Congress, since the same tools used by pharmacy benefits managers, or PBMs, in their discount card programs can be used to lower costs for prescriptions filled by patients during any gap in coverage - for example, before a catastrophic benefit was reached or before patients satisfy a deductible.
A catastrophic benefit would cover some of the costs for people who exceed that cap.
Nonetheless, an unprecedented number of senior citizens are making it clear to Congress that they do not want the catastrophic benefit with its hefty premiums--which fails to address their concern over long-term health care costs.
Additionally, the cost of providing such catastrophic benefits could be reduced through the addition of an early duration deductible that vanishes over time.

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