Virtually every Medicare Advantage Plan and Stand-Alone Part D plans have a $615 deductible on Tier 3 through 5 drugs and then 25% coinsurance on all ensuing refills! 

Most people aren’t aware or have forgotten because they take all generics that have $0 to $10 co-pays that aren’t subject to that deductible.

With the cost of gas and groceries increasing, paying that kind of money out of pocket is a horrifying thought for many seniors on a fixed budget. And this far into the year, you likely won’t reach your out of pocket maximum of $2,100 when covered medications then become $0. Relief for the high costs won’t come for a long time and the deductible, which will most certainly increase in 2027, will need to be paid again in January. 

When doctors prescribe you new medications, they generally don’t know or take into account that you may have a big prescription drug deductible and higher.

If you get put on a new medication, ask your doctor during the appointment if it’s brand name or generic. If you’re told brand, explain to him or her that you have a large deductible and ask if there’s a safe alternative that does come in generic form. 

Here are a couple other tips when it comes to prescriptions:

1. If you’re spending lots of money on medications, ask your pharmacist for recommendations on less expensive alternatives you can then discuss with the prescribing physician. 
2. Ask your doctor for samples and make sure you have a game plan on what to do if he or she runs out. 
3. Don’t forget about PACENET, our Pennsylvania program that covers prescription deductibles and limits the cost of medications to a maximum or $15 for a 30-day supply. Income limits for PACENET are 35,720 for a single person and $45,940 for a married couple. Keep in mind that there are no asset limits! You can have money in savings, a retirement account, stocks or bonds, etc., and still qualify. 
4. If you don’t qualify for PACENET or your state doesn’t have a similar program (most don’t), many drug manufacturers have what are known as Patient Assistance Programs that have higher income limits and often provide medications at no cost. 

If you’re a client and would like us to look at your tax return to see if you qualify for PACENET or a Patient Assistance Program, please reach out to your agent, call the office at 724-603-3403, or email me personally, Aaron@GetYourBestPlan. 

If you’re not a client and would like to inquire about becoming one, we encourage you to reach out as well. Waiting until October and the next Annual Election Period may not be necessary. 

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