How to lower your generic drug copays

Depending on the Medicare Advantage plan you have, how many medications you take and how often you take them, you may be feeling like you’re paying too much for generic prescription drugs.

Medicare Benefits Solutions

Sep 4, 2021

 5 minutes read
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If that’s the case, it might be time to explore your options. You may be able to lower generic drug copays – and save money overall – by switching to a different Medicare Advantage plan.

Finding a plan with lower generic drug copays

Before you start exploring other plans, review the total amount you paid for generic prescription drugs during the last year. Other Medicare Advantage plans with prescription drug coverage (also referred to as MA-PDs) available in your area may offer lower copays for the same generic drugs you currently take.

Compare your current coverage with other plans. If you find a plan that gives you lower generic drug copays, saves you money overall, and still provides you with the coverage you need, you may be able to switch plans during an enrollment period.

If you have questions as you compare plans or need help narrowing down your options based on your personal needs and preferences, a knowledgeable, licensed sales agent is available to help you find the plan that’s right for you.

Comparing generic drug costs

As you compare your current MA-PD generic copays to other available plans, make sure that any MA-PD you consider switching to includes your current medications in their formularies. The formulary is the list of covered drugs. Even though MA-PDs are required to offer a wide range of prescription drugs, the formularies can vary.

 

Some plans may only cover the brand-name version of a medication. If a plan doesn’t include coverage for a generic drug you take, you may end up having to buy the brand-name version that would likely have higher copays. Other plans may not cover the generic drug you currently take – but may cover a different generic version of the same medication with a lower copay.

As you know, Medicare Advantage plans that include prescription drug coverage have tiers, or levels, of pricing based on the categories of covered drugs. Tiers of pricing can vary among plans – and so can the costs of drugs within those tiers.

Tier 1 drugs usually have the lowest copayments and include generic medications. Tier 2 may include non-preferred generic drugs and brand-name medications. Generally the costs go up with each tier.

Aside from the cost of generic drug copays, consider a plan’s benefits and overall costs, including plan premiums, doctor copays and annual out-of-pocket maximum limits. You may find a plan that lowers your generic drug copays, gives you the comprehensive coverage you want, and helps you save money.

The type of Medicare Advantage plan you have may affect your drug costs

Many Medicare Advantage Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) offer prescription drug benefits, although they are not required to do so. As you compare generic drug copays and other costs, you may find that you’ll pay less overall for an HMO, but may have greater flexibility in your care with a PPO.

Medicare Advantage Special Needs Plans (SNPs) are required to include prescription drug coverage. Special Needs Plan formularies are designed to meet the specific needs and circumstances of their enrollees, but costs among plans vary. If you qualify for Medicare and Medicaid and enroll in a Dual-eligible Special Needs Plan (D-SNP), your out-of-pocket costs for drug copays may be much lower.

When can you switch plans?

Once you find a plan with lower generic drug copays, you may be able to switch plans during one of the following Medicare enrollment periods:

  • Annual Election Period (AEP). From October 15 through December 7, you can switch from one Medicare Advantage plan (with or without prescription drug coverage) to another MA plan (with or without prescription drug coverage). If you have Original Medicare and have a stand-alone Prescription Drug Plan (PDP), you can switch from one PDP to another. Or, you can drop Original Medicare and your PDP and enroll in a Medicare Advantage plan with prescription drug coverage. During AEP, you could also drop your MA plan and revert to Original Medicare (and enroll in a PDP at that time).
  • Medicare Advantage Open Enrollment Period. From January 1 through March 31, you have the opportunity to make one change from one Medicare Advantage plan to another.
  • Special Enrollment Periods. If you experience certain life events, you may be able to take advantage of a Special Enrollment Period. For instance, if you move out of a plan’s service area, move into assisted living, or become eligible for Medicaid, you may be able to switch plans.

Ready to potentially lower your generic drug copays?

If your out-of-pocket costs for medications are too high through your Medicare Advantage plan with prescription drug coverage, explore other MA-PD options. You may find a plan with lower copays for the generic drugs you take, reducing your overall costs, and giving you access to the coverage you need.

If you have questions as you compare plans, take advantage of the expertise of a knowledgeable, licensed sales agent who may be able to help narrow down your choices based on your personal needs and preferences, and even help you enroll.

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