Understanding Medicare Prescription Drug Costs
Summary
Understanding how prescription drug coverage works can help you make informed decisions, avoid unexpected costs, and get the most value from your Medicare prescription drug benefit.
The amount you pay for your medications depends on several factors, including your health plan, the medications you take, whether you qualify for Extra Help, and where you are in the prescription drug coverage year.
This section explains the key concepts that affect prescription drug costs and connects you to resources that can help you better understand your coverage.
What Affects What You Pay?
Several factors can impact your prescription drug costs, including:
- Whether your plan has a deductible
- The drug tier assigned to your medication
- Whether you pay a copay or coinsurance
- Whether you qualify for Extra Help (Low-Income Subsidy)
- The stage of prescription drug coverage you are in during the year
- Whether your medication is included on your plan’s formulary
Because every plan is different, your exact costs may vary.
Looking for your plan's specific prescription drug costs?
Find your plan’s Prescription Drug Coverage page to view your deductible, copays, coverage stages, formulary information, and other plan-specific details.
Learn More About Prescription Drug Cost
Key to Terms
Learn the basic terms used to describe prescription drug coverage, including deductibles, copays, coinsurance, formularies, and drug tiers.
Extra Help (Low-Income Subsidy)
Extra Help is a Medicare program that may lower or eliminate prescription drug costs for eligible individuals.
Learn how Extra Help works, who may qualify, and how it can reduce your out-of-pocket expenses.
Understanding Coverage Stages
Prescription drug coverage changes throughout the year as you and your plan spend money on covered medications.
Learn how deductibles, initial coverage, and catastrophic coverage work.
Understanding Coverage Stages →
Ways to Lower Your Prescription Drug Costs
Discover practical strategies that may help reduce prescription drug costs, including generic alternatives, preferred pharmacies, Extra Help, and other cost-saving programs.
Ways to Lower Your Prescription Drug Costs →
Medicare Prescription Payment Plan (M3P)
The Medicare Prescription Payment Plan allows eligible members to spread out-of-pocket prescription drug costs into monthly payments throughout the year.