On Jan. 1, annual deductibles for STRS Ohio’s medical and prescription plans reset. Any amounts you may have accumulated toward your deductibles as of Dec. 31, 2020, do not carry over to the 2021 plan year.
There are separate annual deductibles for medical and prescription coverage. The medical deductible is the amount you must pay before the plan pays a portion of your hospital/medical costs. The prescription deductible is the amount you must pay for covered brand-name drugs, including those designated as specialty drugs, before the plan begins paying a portion of the costs for these drugs. (Generic drugs costs and non-preferred pharmacy fees do not apply to the deductible.)
Let’s take a look at how these annual deductibles work.
Kate is enrolled in the Aetna Medicare Plan.
In 2020, Kate accumulated $150 toward her in-network medical deductible, satisfying it in full. She also accumulated $200 toward her out-of-network medical deductible. On Jan. 1, 2021, accumulated amounts reset to $0. Kate will pay more for services that are subject to the deductible until the 2021 deductible is met. Once the deductible is met, the plan will begin paying a portion of the costs for covered services.
Kate also accumulated $250 toward her prescription deductible in 2020, satisfying it in full. On Jan. 1, 2021, accumulated amounts reset to $0. Kate will pay the full cost of covered brand-name drugs until the 2021 deductible of $275 is met. Once the deductible is met, she will begin paying the applicable copayment/coinsurance for covered brand-name drugs.
At the beginning of each year, your annual deductible slate is wiped clean and the process of meeting the deductible starts over again. Also, annual deductible amounts may change from year to year. If you have questions about annual deductibles, please contact your plan administrator.
More news and information for STRS Ohio Health Care Program participants is available in the Health Care News section of the STRS Ohio website. Enrollees are encouraged to check it regularly.