Nov 252011

The Medicare enrollment deadline is quickly approaching and there have been many television commercials and newspaper articles discussing the various Medicare prescription plans.  However, all of them focus on the premiums and low tier one co-payments, but they all fail to explain some important factors.


Different plans have different pharmacy networks.  Generally you will need to use a network pharmacy to receive benefits; so you will want to make sure that there is a network pharmacy near your home.


This is where the tricky part comes in.  Different insurance companies assign each drug to a tier.  What tier it is in dictates how much of a co-pay you will have to pay when you pick up your prescription.  As for what medications are assigned to what tiers–well it varies plan to plan.

Therefore, to really know if a prescription plan is right for you, you need to know what tiers your prescriptions fall under.

This can be accomplished two ways.  1. Use the benefit comparison tool at 2. Contact each insurance plan you are considering.  You could either call them to request the pharmacy information or go to their website and view their pharmacy information.

You will need to know what tier your medication is in and what the co-pay for that tier is.

Co-pays within Tiers

Often the different tiers have a gradual price increase as you go up in tiers, however, some insurance plans have sharp jumps in price tier to tier.  For example a three tier (tier one is abbreviated T1 and so on) plan may read as: T1 = $15, t2=$35, and T3=$70.  Those are steep price jumps.  However, other plans could read like this: T1=$10, T2=$20, T3=$35, T4=$45, T5=50%

So understanding how many tiers a plan offers, where your medication fits into those tiers, and what the co-payment is for each tier offered is the best way to find out how much money you are going to spend on prescription drugs in addition to any monthly premiums that you pay.




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