Medicare Advantage Copay Amounts: UW Health

UW Health

The copay is the amount you pay when you get a prescription filled. A copay may be a flat dollar amount or a percentage of the total cost of a drug.

Drug maintenance

Prescriptions are often sold in 30-day supplies. However, you can buy up to a 90-day supply on medications in tiers 1 through 4. Each 30-day supply will take one copay at a retail pharmacy. A 90-day supply equals three copays.

If you live in a long-term care facility, your copay is the same as in a retail pharmacy.

You can get prescriptions from an out-of-network pharmacy, but you may pay more.

2024 Copay amounts

Part D vaccines are covered at no cost to you.  You won’t pay more than $35 for a one-month supply of covered insulin, no matter what cost-sharing tier it’s on.

There is a deductible for Tiers 3, 4, and 5. Deductible is: Core D $300; Value D $250; Elite D $200.

Retail 30-dayRetail 60-dayRetail 90-day Mail order
 Tier 1 (Preferred Generic) $5 $10 $15 $12.50
 Tier 2 (Generic) $15$30$45$38
 Tier 3 (Preferred Brand)$47$94$141$117.50
 Tier 4 (Non-Preferred Drug)   $100 $200 $300 $300
 Tier 5 (Specialty) Core D = 28%
Value D = 29%
Elite D = 30%
Tier 6 (Vaccines)$0N/AN/AN/A
Initial Coverage Gap begins at: $5,030 | Catastrophic Coverage begins at: $8,000

Coverage gap

Most Medicare drug plans have a coverage gap every year.

You enter the coverage gap once the total amount spent on Part D drugs reaches $5,030. This includes your payments plus plan payments. During this stage, you pay 25% of the price for drugs, plus a portion of the dispensing fee. You stay in this stage until your year-to-date out-of-pocket (OOP) costs (your payments) reach a total of $8,000. Medicare sets this amount as well as the rules for what counts toward your OOP costs.

Medicare Advantage Drug Information

Looking for information on your drug plan? Reach out to a Quartz Champion, or check your formulary (drug list).