I know I haven’t met my drug plan deductible, but sometimes my drugs are free, and other times, I pay full price. What gives?
It can get confusing. Your deductible is the amount you pay for covered drugs before your plan starts to pay. Those drugs are grouped in tiers. The amount you pay for a drug depends on the tier. In general, the lower the drug tier, the less you pay. Many Medicare drug plans, however, use a “split-tier” deductible, which means that the deductible applies to drugs in the higher tiers (tiers 3, 4 and 5) but not to the lower-cost generics usually found in tiers 1 and 2. Under this structure, enrollees can get many generic drugs for a small or $0 copay before any of the deductible is met, which is why you sometimes get drugs free or for a low cost before meeting your deductible. Detailed information on which drugs or tiers of drugs are subject to your plan’s deductible can be found on your drug plan website or by calling your plan directly.