
MA-PPO prescription drug deductible
Starting January 1, 2025, a new deductible requirement was added to your Cigna True Choice Medicare Advantage PPO (MA-PPO) prescription drug coverage.
The new requirement: You must now meet a $200 annual prescription drug (Part D) deductible before you start paying drug copays. We’ve compiled some Frequently Asked Questions to help you understand this new rule.
Frequently asked questions
What is a deductible?
A deductible is an amount of money you must pay out of your own pocket before your health plan begins to pay benefits.
How does the new prescription drug deductible work?
The new prescription drug deductible is $200 per year. This means you must pay $200 toward the cost of your prescriptions before you begin to pay drug copays.
For example, if your drug costs $60, you will pay the full cost of that drug, but that $60 will apply toward your $200 deductible. Your deductible balance will then be $140 ($200 - $60 = $140).
Another example: If your drug costs $275, you will pay $200 toward the cost — which will satisfy your deductible — plus the copay based on the drug’s tier. If your drug is a Tier 1 generic drug and you fill the prescription at Kroger, you will pay $200 (deductible) + $4 copay = $204.
What happens when I’ve met the $200 prescription drug deductible?
Once the amount you have paid out of your own pocket for prescription drugs equals $200, you will have met the deductible. After you meet the deductible, you will pay only drug copays for the rest of the year or until you meet the plan’s prescription drug out-of-pocket (OOP) maximum of $1,500.
As always, your copay amount is based on:
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The drug’s tier (e.g., Tier 1 is generic, Tier 2 is preferred brand name, etc.)
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Whether you go to Kroger or another pharmacy (Kroger offers lower copays)
What is the prescription drug out-of-pocket maximum?
It is the most you will pay out of pocket for your prescriptions in a given year. For the MA-PPO, the out-of-pocket (OOP) maximum is $1,500; this includes amounts paid toward the deductible and drug copays.
Once you meet the annual OOP maximum, you pay $0 for prescription drugs — no more copays — through the end of the year.
Does the $200 prescription drug deductible start over on January 1?
Yes.
Do I have any other deductibles with my coverage under the MA-PPO?
Yes. You also have a Part B deductible of $150. Part B services include things like doctor’s visits, outpatient care and ambulance services.
Part B also includes:
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Durable medical equipment (DME) like wheelchairs and walkers as well as items used with DME like diabetes test strips used with a blood glucose meter
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Certain drugs that you typically wouldn’t give to yourself, like those given in a hospital outpatient setting
If your prescription falls under Part B (like DME) — even though you pick it up at the pharmacy — you have to meet your Part B deductible first.
Did you know...
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Your MA-PPO plan has an enhanced drug list (formulary). It includes hundreds of preventive drugs. You pay $0 — no deductible or copays — for drugs on this list. You can view this list here.
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For 2025, the Centers for Medicare & Medicaid Services lowered the annual out-of-pocket (OOP) maximum for part D drugs to $2,000. But your OOP maximum is even lower at $1,500! This is good news because you will pay no more than $1,500 a year for your prescriptions.
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Prescription drug deductible basics
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Amounts you pay toward the prescription drug deductible count toward the cost of the drug(s).
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You can’t pay prescription drug copays to satisfy your deductible.
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You have separate annual out-of-pocket maximums for medical services ($2,000) and prescription drugs ($1,500).
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Some drugs are covered under Part B rather than Part D. Cigna has a flier that discusses how Medicare covers different medications. View it here.
Stay in the know about your retiree benefits
MNPS and Cigna use a variety of ways to keep informed about your retiree benefits and any changes to your coverage.
For example, we:
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Hold meetings, both in-person and virtual
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Attend MNRTA meetings
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Mail Annual Transfer packets and Annual Notice of Change (ANOC) docs
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Record Brainshark videos
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Post important information on myCigna.com and MNPSBenefits.org/retiree
We encourage you to check out these resources. If you still have questions, you can call MNPS Employee Benefits at 615-615-259-8464 or 615-259-8648.
EMPLOYEE BENEFIT SERVICES
615-259-8607
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