Wednesday, October 28, 2009


Understand Part-D drug TIERS, cost levels, then SAVE..

Doctors sometimes are quick to recommend the newest thing on the market, well generally the "newest" is the most expensive. On most Medicare Part-D drug lists (formularies or covered drugs) the newer brand-name drugs are the highest tier=highest priced drugs. It's not likely your physician will know the Tier system of your Part-D provider. It's impossible for him to have the data/lists from all the D providers. Each D provider has different drugs listed in each tier. It's up to you know and understand your own Plan-D, know it's Tier system and co-pays/co-insurance costs, and especially its formulary (covered drug list). Where your prescriptions are on the list (by tier) determine how much you pay and when/if you go to the "Donut". Ask your Medicare advisor about your plan's tier levels, specific drugs you take, what tier, how much? 

Your plan's Drug Formulary List with have your drug's tier cost level. Then know your pharmacy's retail price for the drug. The co-pays are fixed dollar amounts, however the last top tier levels are a percentage co-insurance amount of retail costs. Simple multiply the percent times the retail cost. Example....$400 retail cost at 35% co-insurance cost is $140 dollars you will pay. Copay amounts are fixed, known prices and the co-insurance amounts are non-fixed prices, many times an unpleasant surprise.

THE TIERS 1 and 2 ARE THE LOWEST PRICES on the four-tier type.

THE TIERS 1, 2, and 3 ARE THE LOWEST PRICES on the five-tier type, thus offering greater numbers of fixed-payment, copay drugs.

Understand the Plan D Tier System:

Sometimes you must coach your doctor and ask about prescribing generics and lower tier drugs that are less costly. REMEMBER: IT'S WHAT YOU AND YOUR PLAN-D PAY TOGETHER EACH YEAR THAT DETERMINES WHEN YOU REACH THE DONUT, for 2015 the amount is $2960, then "'re in the Donut"! We consistently use MEDICARE.GOV plan finder for Part D. We add a clients drugs, pharmacy, and provider plan, then it tells us costs and Donut information. It even shows the monthly costs!

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Best to your health, AL

1 comment:

AL said...

The best explanation of Medicare Plan-D is at:


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I work for Seniors with all the Medicare Plans & Sr.Financial Planning... I saw what was happening in the homes of senior families and sacrifices seniors made for their prescriptions & health coverage. So I built a Saving & Educational place for my Seniors & their Families. I had my 1st Medicare Plan job in 1979. I worked for some large Wall Street firms years ago, there I was educated in senior's finance/safe investing, finished my CFP educational requirement in 01'. Now, I am a Plan Broker representing more 172 Medigap-Sups, Plan C Advantage, & Drug Plans. Now, I just apply my education & skills to benefit "Senior Families".. From Federal Housing to Assisted Living to Golf Course Patios, it's the same mission: Education & Healthcare; bringing SAVINGS-SECURITY-DIGNITY. We welcome comments on any posts. Remember, this is a WWW platform so protect your identity, you can post anonymously. Call us Toll-Free 855-SENIOR6 for private help. THE SENIOR FAMILY ALLIANCE IS NOT AFFILIATED WITH THE U.S.GOVERNMENT, STATE DHS, OR MEDICARE. ONLY COMPENSATED BY THE PROVIDER COMPANIES OF THE PLANS. PLAN DETAILS PRESENTED UNDER MEDICARE SOA RULES.