Paying for Medicare

You will pay for a portion of your Medicare coverage. How much you'll pay depends on the plan(s) you select and the health care you receive. Before you decide on a Medicare plan, learn how Medicare shares costs with you. Once you understand cost sharing, you can make a more informed choice and start budgeting for future expenses.

Not everyone can afford to cover Medicare costs. If you have a low income and limited assets, you may qualify for extra help. If eligible, you can get help paying your premiums, deductibles and prescription drug copays and coinsurance.

Understand cost sharing

Learn about premiums, deductibles, copays and coinsurance.
Read more about cost sharing

Manage the Medicare Part D coverage gap

Learn about the coverage gap and ways to delay it.
See tips for lowering drug costs

Get help with prescription drug costs

Extra help is available to people with limited incomes. Find out if you qualify.
See eligibility requirements

Get help with Medicare costs

If you can't cover your Medicare expenses, help is available.
Learn about financial aid programs

Pay for Medicare

Depending on your plan and financial situation, you have choices for paying for premiums.
View the ways to pay for Medicare

Questions? Call UnitedHealthcare at:
1-877-699-5710
(TTY 711)
Hours: 8 a.m.-8 p.m. local time,
7 days a week

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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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