Why prescription costs vary so much under Medicare

Original Medicare — Parts A and B — does not cover most prescription drugs. To get drug coverage, beneficiaries typically need to add a standalone Part D plan. Part D plans are not all the same. Each plan may cover medications differently and have different costs. Formularies differ, cost-sharing structures differ, and what you pay for the same medication can vary widely from one plan to the next.

Many beneficiaries stay on the same plan year after year without realizing their drug costs have changed — or that better options may exist in their area.

How Medicare Advantage plans with Part D coverage can help

Most Medicare Advantage Prescription Drug plans bundle Part D drug coverage directly into the plan, which means one monthly premium covers both your medical and prescription benefits. Beyond consolidation, these plans may offer cost advantages that standalone Part D plans don't.

Formularies designed around your conditions

Medicare Advantage plans — particularly Special Needs Plans built for chronic conditions — often structure their drug formularies around the medications most commonly prescribed for their target population. That can mean lower cost-sharing on the specific drugs you take most.

$0 copays on select medications

Some Medicare Advantage Prescription Drug plans offer $0 copays on certain generic or preferred brand-name drugs. Availability depends on the plan's formulary and tier structure, but for beneficiaries on maintenance medications, this can add up to meaningful savings over a year.

Out-of-pocket cap on drug costs

Under current Medicare rules, Part D plans include a cap on annual out-of-pocket drug spending. Once you reach that cap, you pay nothing for covered Part D drugs for the rest of the year. This protection is built into Medicare Advantage Prescription Drug plans.

Mail-order pharmacy options

Many Medicare Advantage Prescription Drug plans offer a mail-order pharmacy benefit, which can reduce the per-dose cost of maintenance medications and eliminate the need for monthly trips to the pharmacy.

NOTE: Drug coverage, formularies, and cost-sharing vary by plan and location. Not all medications are covered under every plan. Reviewing a plan's formulary before enrolling is the only way to know how your specific prescriptions are covered.

What to look for when comparing drug coverage

When evaluating a Medicare Advantage Prescription Drug plan's drug coverage, the most important thing to check is whether your specific medications are on the plan's formulary and at what tier. Lower tiers generally mean lower cost-sharing. You'll also want to confirm which pharmacies are in-network and whether a mail-order option is available.

A licensed insurance agent can pull up plan formularies for your area, check how your current medications are covered under each option, and help you identify the plan most likely to reduce what you pay at the pharmacy.

Senior happily talking on the phone to enroll in a plan

How to find a plan that works for your prescriptions

Plan availability and formularies are local and change year to year. The only way to know whether a better option exists for your specific medications is to compare plans based on what you actually take. Doing that comparison with a licensed agent costs nothing and can save you from out-of-pocket expenses you didn't see coming.

See which plans in your area offer
coverage for your prescriptions

Answer a few quick questions and a licensed Medicare agent will walk you through your options — at no cost to you.

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We represent Medicare Advantage plans with the following carriers:AETNA BETTER HEALTH INC. (NJ)®, Aetna®, Florida Blue Medicare®, HealthSpring℠, UnitedHealthcare®, Care N Care®, Clover Health®, Allina Health |Aetna Medicare®, Zing Health Inc.®, Wellcare®, Molina Healthcare®, Anthem Blue Cross and Blue Shield