Medicare prescription drug plans (Part D) are required to cover a vast amount of prescription medications, which can be found on their formulary. Each prescription drug that is covered in the Medicare Part D Plan’s formulary is placed into a tier, and each tier consists of different prices. A formulary consists of both brand name and generic medications, ensuring the best treatment for Medicare Part D participants.
If your medication is not included in the formulary issued by your Medicare Part D Prescription Plan, then you and your physician may apply for an “exception,” meaning that the physician knows no other drug on the formulary will treat the patient. The doctor must submit a statement explaining why an exception is necessary.
Medicare Part D Tier Types
Many insurance companies will divide their formulary into different tiers in order to create lower prescription costs for Medicare patients that have a Medicare Part D Plan. Each drug insurance plan may divide its own tiers differently, but an example of Medicare Part D tiers is as follows:
- Tier 1: lowest copayment, typically common generic drugs
- Tier 2: medium copayment, preferred, brand-name prescription drugs
- Tier 3: higher copayment, non-preferred, brand-name prescription drugs
- Specialty Tier: highest copayment: most expensive prescription drugs
This is an example of how tiers may be divided. Private insurance companies that offer Medicare Part D plans may differ from this tiered setup. It is important to stay educated about your insurance plan’s tier types and coverage offered.
Medicare Part D Tiers in Alabama
In Alabama, the number of Medicare recipients is just over one million residents. Approximately one-third (33%) of those one million residents are enrolled in a stand-alone Medicare Part D Prescription Coverage Plan, while 44% are enrolled in a plan combined with a Medicare Advantage plan.
In Dothan, Alabama, there are only 19 Medicare Part D Prescription Plans offered in their coverage area, with monthly premiums ranging from $7.30 to $86.50. Their lowest premium plan is divided into five tiers. This plan also has a deductible of $445 for all tiers, excluding tier one. This plan’s tiers are broken down into the same categories mentioned above.
Enterprise, Alabama also offers the same type of Medicare Part D prescription drug plans as Dothan, Alabama.
Medicare Part D Tiers in Florida
In Florida, approximately 4.6 million residents receive Medicare coverage. Many Medicare recipients choose a Medicare Advantage Plan with prescription drug coverage, rather than simply enrolling in a stand-alone Medicare Part D Plan. As of 2021, Florida offers 28 stand-alone Medicare Part D coverage plans, with monthly premiums ranging from $7 to $172.
In Pensacola, Florida, 21 Medicare Part D coverage plans are available to choose from. The lowest monthly premium plan requires a $445 deductible to be met before coverage, but only in tiers 2-5. Some offer full coverage with no deductible, typically for Tier One medications, while others require the deductible to be met before copay costs are lowered and coinsurance coverage is applied.
In Pace and Tallahassee, Florida, there are also 21 Medicare Part D plans available to choose from, with monthly premiums ranging from $7.30 to $172.00.
Want to Learn More?
If you live in Dothan or Enterprise, Alabama, or even Pensacola, Pace, or Tallahassee, Florida, Sunsurance Agency is ready and dedicated to helping you find the prescription drug coverage you need.
Give us a call today and we can walk you through all your options by comparing coverage and costs!