Copayment/coinsurance in drug plans

The amount you pay for each prescription after you've paid your 

Deductible [glossary]

 (if your plan has one) is either:

  • A Copayment . With a copayment, you pay a set amount (like, $10) for all drugs on a tier. For example, you may pay a lower copayment for generic drugs than brand-name drugs.
  • Coinsurance . With coinsurance, you pay a percentage of the cost (like, 25%) of the drug.

Some Medicare Prescription Drug Plans have levels or "

Tiers

" of copayments/coinsurance, with different costs for different types of drugs.

Note

Usually, the amount you pay for a covered prescription is for a one-month supply of a drug. However, you can request less than a one-month supply for most types of drugs. You might do this if:

  • You’re trying a new medication that’s known to have significant side effects.
  • You want to synchronize the refills for all your medications.

If you do this, the amount you pay is reduced based on the amount you actually get. Talk with your prescriber to get a prescription for less than a one-month supply.