Our Medicare Prescription Plan Services
We understand that the cost of prescription medications can place a significant burden on seniors, especially those living on fixed incomes.
That's why we offer a range of Medicare Part D prescription drug plans designed to meet your unique needs and budget. Whether you're managing a chronic condition or simply need occasional prescriptions, our team will work tirelessly to find the right plan for you, providing peace of mind and financial relief.
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Prescription Formularies & Tiers
Medicare Formularies
Think of a formulary as a list of prescription drugs covered by your Medicare Part D plan. Each plan has its own formulary, which outlines the specific medications it covers. These formularies are created by insurance companies and approved by Medicare. Formularies typically include generic and brand-name drugs, but not every medication will be covered.
Prescription Tiers
Within a Medicare formulary, drugs are often grouped into tiers based on their cost and how they're covered by your plan. The tier a drug is placed in determines how much you'll pay out of pocket when you fill a prescription.
Tier 1
Tier 2
Tier 3
Tier 4
Copayments
A copayment is a fixed amount you pay for a prescription medication when you pick it up from the pharmacy.
Your copayment may vary depending on the tier of the drug as well as your specific Medicare Part D plan. For example, you might have a $10 copayment for Tier 1 generic drugs and a $40 copayment for Tier 3 brand-name drugs. Copayments help share the cost of medications between you and your insurance company.
Coverage Gaps
Medicare Part D plans include what's known as the "coverage gap" or "donut hole."
This is a period where you may have to pay more for your prescription drugs out of pocket. Once you and your plan have spent a certain amount on covered medications for the year (reaching the initial coverage limit), you enter the coverage gap. During this time, you'll typically pay a percentage of the cost of your medications until you reach a certain out-of-pocket threshold. After that, catastrophic coverage kicks in, and your costs decrease significantly.
