Frequently Asked Questions about Cost-sharing: What You Pay

You will never pay more than your Medicare Part D plan's negotiated retail drug price - so even when your low-costing generic drug is placed on an expensive formulary tier - you will pay the lower retail cost and not the higher co-pay.

In most cases, you must pay your Medicare Part D plan's Initial Deductible before you receive Medicare Part D coverage - just as you would with other types of insurance, such as automobile insurance. . . .

You will pay the Tier 1 or Tier 2 co-payment for your medications, if these two formulary tiers are excluded from the initial deductible - even when the plan's initial deductible is not yet met. Ex . . .

The initial Coverage Phase is the second part of your Medicare drug plan and follows the Initial Deductible (if your plan has a deductible). During this phase, you and your Medicare Part D plan share in the cost of your formulary drugs (for example, you pay $47 for a $500 drug).

Cost-Sharing is the portion of your Medicare Part D or Medicare Advantage plan coverage that you pay yourself - such as $47 for a Tier 3 brand-name drug that usually costs $250 retail or $20 to visit your primary care physician (PCP) or $75 to see a healthcare specialist.

Your Medicare plan must tell you what you will pay for cost-sharing and cost-sharing information can be found in your plan's Summary of Benefits document (that you receive when enrolling in a Medica . . .

Probably. Although each Medicare Part D prescription drug plan (PDP or MAPD) has a national pharmacy network that includes 50,000 to 60,000+ pharmacies, preferred network pharmacies usually have lower cost-sharing as compared to standard network pharmacies.

You can review your plan's Annual Notice of Change letter (ANOC) that your Medicare plan will send you in late-September or early-October of every year. You can also use our https://PDP-Compare.com or https://MA-Compare.com tools to see annual changes in Medicare plan co-pays.

Depending on where you are within your Medicare Part D coverage, a portion of your medication cost is paid by one or more of the following: you, your Medicare plan, the brand-name . . .

Hopefully soon.  On July 9, 2021, Executive Order 14036 - Promoting Competition in the American Economy was signed.  In an effort to promote competition, the order states,"To reduce the cost . . .

Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% co-insurance), you will find your coverage cost increases (or decreases) du . . .

Probably not.  In some situations, you have the right to ask your Medicare Part D prescription drug plan (PDP or MAPD) to have a higher-costing drug moved to a lower-costing formulary tier and th . . .

Hopefully soon.  On July 9, 2021, Executive Order 14036 - Promoting Competition in the American Economy was signed.  In an effort to promote competition, the order states,"To reduce the cost . . .

Depending on where you are within your Medicare Part D coverage, a portion of your medication cost is paid by one or more of the following: you, your Medicare plan, the brand-name . . .

Cost-Sharing is the portion of your Medicare Part D or Medicare Advantage plan coverage that you pay yourself - such as $47 for a Tier 3 brand-name drug that usually costs $250 retail or $20 to visit your primary care physician (PCP) or $75 to see a healthcare specialist.

Probably. Although each Medicare Part D prescription drug plan (PDP or MAPD) has a national pharmacy network that includes 50,000 to 60,000+ pharmacies, preferred network pharmacies usually have lower cost-sharing as compared to standard network pharmacies.

You will pay the Tier 1 or Tier 2 co-payment for your medications, if these two formulary tiers are excluded from the initial deductible - even when the plan's initial deductible is not yet met. Ex . . .

Your Medicare plan must tell you what you will pay for cost-sharing and cost-sharing information can be found in your plan's Summary of Benefits document (that you receive when enrolling in a Medica . . .

In most cases, you must pay your Medicare Part D plan's Initial Deductible before you receive Medicare Part D coverage - just as you would with other types of insurance, such as automobile insurance. . . .

The initial Coverage Phase is the second part of your Medicare drug plan and follows the Initial Deductible (if your plan has a deductible). During this phase, you and your Medicare Part D plan share in the cost of your formulary drugs (for example, you pay $47 for a $500 drug).

Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% co-insurance), you will find your coverage cost increases (or decreases) du . . .

You can review your plan's Annual Notice of Change letter (ANOC) that your Medicare plan will send you in late-September or early-October of every year. You can also use our https://PDP-Compare.com or https://MA-Compare.com tools to see annual changes in Medicare plan co-pays.

You will never pay more than your Medicare Part D plan's negotiated retail drug price - so even when your low-costing generic drug is placed on an expensive formulary tier - you will pay the lower retail cost and not the higher co-pay.

Probably not.  In some situations, you have the right to ask your Medicare Part D prescription drug plan (PDP or MAPD) to have a higher-costing drug moved to a lower-costing formulary tier and th . . .