Frequently Asked Questions about Cost-sharing: What You Pay

Aug, 25 2022 — 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.

Aug, 28 2022 — The Centers for Medicare and Medicaid Services (CMS) provides the following guidance explaining how Medicare beneficiaries can receive a refund or repayment of their overpaid copayments and premiums f . . .

Jan, 12 2023 — 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 . . .

Jan, 22 2023 — 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 . . .

Jan, 27 2023 — 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).

Sep, 18 2022 — Cost-Sharing refers to 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.

Nov, 09 2021 — 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 . . .

Nov, 13 2022 — 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.

Oct, 29 2022 — When you enroll in a Medicare Part D prescription drug plan, you will pay a certain price for your Part D drugs that are covered by your plan's formulary.  In the Initial Deductible (if your plan . . .

Nov, 10 2022 — 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.

Sep, 16 2022 — Co-Payment or Co-Pay is a type of cost-sharing that refers to a fixed dollar amount you pay for a medication assigned to a logical grouping or Tier of medications. As reference, the Centers for M . . .

Aug, 28 2022 — Depending on the stage of 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 drug man . . .

Nov, 29 2022 — Co-Insurance is a type of cost-sharing used by Medicare Part D prescription drug plans or Medicare Advantage plans referring to a Medicare plan member paying a percentage of the medication's negotiate . . .

Aug, 28 2022 — The Copayment, according to the Centers for Medicare and Medicaid (CMS) is defined as: In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a docto . . .

Aug, 27 2022 — Hopefully soon. As noted by the [Food and Drug Administration (FDA)]: "On March 31, 2022, the FDA held a meeting with representatives from several states [Florida, Colorado, Vermont, Maine, and New Me . . .

Aug, 28 2022 — 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 . . .

Aug, 21 2022 — 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 . . .

Jan, 27 2023 — 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).

Jan, 22 2023 — 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 . . .

Jan, 12 2023 — 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 . . .

Nov, 29 2022 — Co-Insurance is a type of cost-sharing used by Medicare Part D prescription drug plans or Medicare Advantage plans referring to a Medicare plan member paying a percentage of the medication's negotiate . . .

Nov, 13 2022 — 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.

Nov, 10 2022 — 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.

Oct, 29 2022 — When you enroll in a Medicare Part D prescription drug plan, you will pay a certain price for your Part D drugs that are covered by your plan's formulary.  In the Initial Deductible (if your plan . . .

Sep, 18 2022 — Cost-Sharing refers to 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.

Sep, 16 2022 — Co-Payment or Co-Pay is a type of cost-sharing that refers to a fixed dollar amount you pay for a medication assigned to a logical grouping or Tier of medications. As reference, the Centers for M . . .

Aug, 28 2022 — The Centers for Medicare and Medicaid Services (CMS) provides the following guidance explaining how Medicare beneficiaries can receive a refund or repayment of their overpaid copayments and premiums f . . .

Aug, 28 2022 — Depending on the stage of 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 drug man . . .

Aug, 28 2022 — 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 . . .

Aug, 28 2022 — The Copayment, according to the Centers for Medicare and Medicaid (CMS) is defined as: In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a docto . . .

Aug, 27 2022 — Hopefully soon. As noted by the [Food and Drug Administration (FDA)]: "On March 31, 2022, the FDA held a meeting with representatives from several states [Florida, Colorado, Vermont, Maine, and New Me . . .

Aug, 25 2022 — 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.

Aug, 21 2022 — 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 . . .

Nov, 09 2021 — 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 . . .