• Kyla


Ever wonder how your Medicare Advantage Drug plan really works? Here is an easy way to understand how your Medicare Advantage Drug plan works:

DEDUCTIBLE: First you will have to pay your deductible for any Tiers which require a deductible to be met. This means you pay 100% of your prescription drugs until you each your deductible (your deductible can be as low as $0 and will not exceed $415 for the 2019 plan year).

This deductible is a onetime payment for the year you are currently in, and will become due again when the new year begins and you have drugs in a tier where a deductible must be met. A lot of plans waive the deductible for Tiers 1 & 2. Make sure to review your plan for your specific deductible amount and for what Tiers you must pay your deductible for (usually Tiers 3-5).

INITIAL BENEFIT LIMIT: You pay 25% of the drug costs and the insurance pays the other 75%, until the total spent between the two of you, INCLUDING DEDUCTIBLE PAID, reaches your initial coverage limit of $3,820.

COVERAGE GAP (aka "donut hole"): The Brand Name drugs during this stage are discounted by the manufacturer at 70% which leaves you owing 25% for Brand Name drugs and the insurance owing 5%. For Generic drugs you will owe 37% and the insurance company will owe 63%. Once the total paid by you and the insurance company reaches $5,100, INCLUDING the $3,820 from above Deductible & Initial Benefit Limit (difference of $1,280) you will move to the Catastrophic Coverage.

CATASTROPHIC COVERAGE: Once your total reaches $5,100 your plan pays most of the costs...you pay whichever of these is greater: 5% co-insurance or $3.40 co-pay for Generic drugs. You pay whichever of these is greater: 5% co-insurance or $8.50 co-pay for Brand Name drugs. You will remain on Catastrophic Coverage for the remainder of the calendar year, once you reach this point in your drug plan.


1) Keep in mind that each Medicare Advantage plan has different deductibles, co-insurance and co-payments so make sure to "look around" for the plan that works best f you.

2) Keep in mind that if you use a "Preferred" pharmacy, if offered, you will pay a lower cost for your drugs than using their "Standard" pharmacy list.

3) Keep in mind that if you purchase a 3 month supply via mail order, some company's offer 3 months of drugs for the cost of 2.

4) Keep in mind that if you don't choose a Part D plan with Original Medicare, or a Medicare Advantage plan which includes a RX plan you may have to pay a penalty for every month you could have enrolled in a plan with Drug coverage, but didn't. There are a few exceptions such as having creditable drug coverage through your active work insurance (not COBRA).

You should now be able to understand Medicare Advantage drug plans a whole lot better!



Medicare and You 2021 Handbook, 2021 Medicare and You Booklet, Discounts on Cannabis, Cannabis MedPlan for 60 days $1.00, Cannabis try before you busy $1.00, Discounted recreational cannabis, discounted CBD & THC, CBD & THC Medical Plans,Cannabis Medicare Plans, CBD & THC Medicare plans, CBD & THC discounts, Silver & Fit, Where can I find the 2020 Retirement Tax Guide, Where can I find 2020 Federal Poverty Level, 2020 Tax Brackets, Tax Inflation Adjustments for 2020, 2020 Social Security Schedules, 2020 Capital Gains and Qualified Dividend Rates, 2020 Uniform Lifetime Table, 2020 Federal Estate Gift Generation skipping transfer tax, HSA Amounts for 2020, 2020 Health Savings Amounts, 2020 Retirement Tax Guide Available now. Health Insurance plans and rates book online now, 2020 Marketplace Health Insurance, Medicare, What is Medicare, How does Medicare work, Where do I sign up for Medicare, Do I have to sign up to get Medicare, When does Medicare start, Medicare Broker, Medicare Agent, Medicare Producer, Medicare made easy, Medicare Explained, Medicare basics, Medicare for 65 and over, Medicare Quotes, Medicare Rates, Oregon Medicare, Aliera offers Health Share plans all year long.  Health Share Medical, Health Share Catastrophic plans, Health Share Short Term Medical plans.  Purchase coverage for your health outside Open Enrollment.  Catastrophic coverage, Other health insurance options, health insurance, Medicare options with Aliera  YELP REVIEW, ONESHARE, Our Yelp Page, Read my Medicare Blog, Medicare Made Easy, Medicare for Dummies, Part D Medicare, Medicare Advantage plans explained, How do I apply for MEdicare, How do Medicare Advantage drug plans work, Help with Medica, Disability Insurance in ORegon, Indemnity plans, Gap Plans, Gap Insurance.re and Medicare Advantage plans, Finding a Medicare advantage broker, Medicare Brokers, Medicare where to start, Disability Insurance, Gap Plans, Cancer Insurance, Accident Insurance, Short Stay Plans, Medical Share Plans, Christian Medishare, Agentreview, agentreview.net