Enhanced alternative (EA) coverage is Part D coverage that includes supplemental benefits, as well as the basic prescription drug benefits offered under DS, AE, and BA coverage. The value of the drug coverage exceeds that of DS, AE, and BA coverage. Supplemental benefits may include:

• reductions in cost-sharing in the coverage gap
• reductions in cost-sharing that increase the actuarial value of the benefits provided above the actuarial value of DS coverage (e.g., through a reduction in the deductible, reduction in cost-sharing in the initial coverage period, and/or increase in the initial coverage limit [ICL]); and/or
• coverage of drugs or classes of drugs that are excluded or otherwise restricted from coverage under Part D.
• Enhanced alternative (EA) coverage is Part D coverage that includes supplemental benefits, as well as the basic prescription drug benefits offered under Defined Standard (DS) benefit, Actuarially Equivalent Standard (AE) benefit and Basic Alternative coverage.

• LIS cost-sharing support
• State Pharmacy Assistance Programs, (not in MN)
• Indian Health Service and certain other Native American organizations
• AIDS Drug Assistance Programs

• Please note: Veterans benefits are NOT considered TrOOP costs

With an enhanced alternative plan, supplement coverage payments made by the plan are applied to TrOOP.

For example, the plan has a tier copay amount of $30. The plan member pays their deductible and then $30 in the initial coverage phase and the plan pays 25% of the cost of the medication under the enhanced alternative plan structure.

That 25% is applied to the out-of-pocket, which helps the person move through the $2,000 cap. You will not see this on the cost estimator, but this is why it says the $2,000 cap is reached by the middle of the year. This new way of applying the supplemental coverage is why staff really need to pay attention to the type of plan, whether it is basic or enhanced. The cost estimator can only show the amount the plan member is actually liable for, the deductible (if any), and the member copay/coinsurance amount. No other payments are displayed. 

If the results in the Plan Finder and Prescription Payment Plan Wizard show that less than $2,000 in annual covered drug costs are to be paid:

• First, check if the plan reviewed is on the list of EA plans in Minnesota (see below).
• If the plan is an EA then you can conclude that the results that show less than $2,000 in annual costs is accurate and you can proceed with assisting the beneficiary.
• If the plan is not an EA, then you can conclude that the results are not accurate. Take screen shots of the results and submit them with a support request form.
  • Inform the beneficiary that the results do not appear to be accurate as they should total $2,000 if the plan being reviewed is not an EA plan.
• Review other plan options the beneficiary is interested in and review the $2,000 cost results.