Frequently Asked Questions about Cost-sharing: What You Pay

Jun, 24 2024 — 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.

Feb, 02 2024 — 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 . . .

May, 24 2024 — 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, 03 2024 — You will only pay the Tier 1 or Tier 2 copayment 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. . . .

Jul, 13 2024 — 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).

Jun, 04 2024 — 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.

Jun, 24 2024 — Cost-sharing is the portion of your prescriptions or healthcare that is paid by you or your insurance company (or other payer).  For example, if you purchase a Tier 3 formulary medication that ha . . .

Jun, 24 2024 — 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.

May, 28 2024 — 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 . . .

Jul, 28 2024 — Starting January, 1, 2025, the Inflation Reduction Act (IRA) limits a Medicare drug plan member's out-of-pocket spending for formulary drug Medicare Part D drugs to $2,000.  Once the plan member . . .

Apr, 20 2024 — 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 copays.

Aug, 07 2024 — 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 drug plan, Pharmaceutical com . . .

May, 25 2023 — Copayment or copay 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 Me . . .

Jul, 20 2024 — Coinsurance 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 negotiated . . .

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 . . .

Jun, 09 2024 — Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% coinsurance), you will find your coverage cost can increase (or decrease) d . . .

Jun, 09 2024 — Hopefully soon. On January 5, 2024, the Food and Drug Administration (FDA) authorized "Florida’s Agency for Health Care Administration’s drug importation program under section 804 of t . . .

Jul, 19 2024 — Probably not. In some situations, you have the right to ask your Medicare Part D prescription drug plan to move a higher-costing drug to a lower-costing formulary tier. However, usually such a "tiering exception" is not available for plans with only one Specialty Drug

Aug, 07 2024 — 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 drug plan, Pharmaceutical com . . .

Jul, 28 2024 — Starting January, 1, 2025, the Inflation Reduction Act (IRA) limits a Medicare drug plan member's out-of-pocket spending for formulary drug Medicare Part D drugs to $2,000.  Once the plan member . . .

Jul, 20 2024 — Coinsurance 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 negotiated . . .

Jul, 19 2024 — Probably not. In some situations, you have the right to ask your Medicare Part D prescription drug plan to move a higher-costing drug to a lower-costing formulary tier. However, usually such a "tiering exception" is not available for plans with only one Specialty Drug

Jul, 13 2024 — 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).

Jun, 24 2024 — 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.

Jun, 24 2024 — Cost-sharing is the portion of your prescriptions or healthcare that is paid by you or your insurance company (or other payer).  For example, if you purchase a Tier 3 formulary medication that ha . . .

Jun, 24 2024 — 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.

Jun, 09 2024 — Hopefully soon. On January 5, 2024, the Food and Drug Administration (FDA) authorized "Florida’s Agency for Health Care Administration’s drug importation program under section 804 of t . . .

Jun, 09 2024 — Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% coinsurance), you will find your coverage cost can increase (or decrease) d . . .

Jun, 04 2024 — 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.

May, 28 2024 — 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 . . .

May, 24 2024 — 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 . . .

Apr, 20 2024 — 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 copays.

Feb, 02 2024 — 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, 03 2024 — You will only pay the Tier 1 or Tier 2 copayment 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. . . .

May, 25 2023 — Copayment or copay 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 Me . . .

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 . . .