Ikey Fowler

Ikey Fowler

Last week we discussed prescription drug plan premiums, deductibles and coinsurance. This week we will continue to look at Medicare prescription drug plans by looking at copays, formularies and provider networks. When choosing a prescription drug plan these six things are very important to consider.

A copay is a fixed amount you pay for each individual prescription. Copays can vary depending on the tier of your prescription. Typically the lower the tier, the lower the copay. A tier 1 drug usually has a lower copay than a tier 2 drug, tier 2 drugs have a lower copay than tier 3, etc. Because different plans may categorize drugs in different tiers it’s a good idea to know how your plan treats your prescriptions.

The prescription drug plan’s formulary will tell you two important things. First, it will tell you if the prescription you are taking is covered under the plan. Second, it will tell you the tier of the prescription. Knowing the tier of your prescription is important in determining the copay. For example, Plan A may list your prescription as a tier 2 whereas, Plan B may have it as a tier 3. This should tell you that Plan A will have a lower copay on your prescription than Plan B. It will also tell you if your drug will fall in the deductible phase of the plan.

The plan’s provider network is a list of pharmacies that accepts the plan. All pharmacies do not accept all plans so if you have a particular pharmacy you would like to use check to make sure they accept your plan. You can do this by simply asking your pharmacist. Also, pharmacies are listed as “preferred” and “standard” under some plans. In this case a “preferred” pharmacy may have lower copays than a “standard” pharmacy.

If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at ikey@alabamahealthguidance.com

Alabama Health Guidance is an independent insurance agency and is not affiliated with Medicare or any other government agency.