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If I Have Medicare Advantage and Medicaid How Will My Prescription Drug Coverage Work?

If you have Medicaid and Medicare, you may be wondering how these services interact with each other and how your preciption drug coverage will work, well in this article we will explain how this coverage works and what you may have to pay.

There are four levels of prescription drugs. The lower the level of drug coverage, less you will have to pay with your medicaid/medicare service. Although, it is ultimatley left up to the medicaid plan you chose how much you will have to pay if you do not have Medicare plan D.

Level One Prescriptions: These are normally generic brand and low-cost drugs. These are normally very inexpensive drugs to begin with so you will not have to expect to pay much for these, if anything at all, you can expect to pay maybe $10 for these prescriptions depending on your plan.

Level Two Prescriptions: These are normally generic brand drugs and are more expensive than the level ones. These drugs are typically not extremely expensive because they are still generic, yet it is still something to keep in mind. You can expect to pay anything from $15 to $20 for these depending on your plan.

Level Three Prescriptions: These prescriptions are brand name drugs and are more expensive. There may be generic drugs or brand alternatives to Levels One and Two that can help you save money. This is a good option if you do not have enough for the level three prescription which is normally around $30 to $50 dollars depending on the plan.

Level Four Prescriptions: This includes self-injectable drugs that have high technology medications. These drugs may have a greater price than drugs that are Levels One, Two or Three. These are often drugs that are very expensive, and you are often required to pay 50% of the cost depending on the plan you chose.

Paying an Annual Deductible: Level one drugs, including many generic drugs are not subject to deductible and have the lowest copay. You pay an annual deductible for drugs in levels two, three and four combined. This is something to consider when choosing your medicaid and medicare plan.

Group A Drugs: These drugs have the greatest capacity to prevent serious medical episodes. This group includes drugs for conditions such as asthma, infections, depression and juvenile diabetes. Drugs to prevent pregnancy are also in this group. These are some of the drugs that you will pay the lowest amount for.

Group B Drugs: These are drugs to control long-term conditions. This group includes drugs that treat cancer, heart disease and multiple sclerosis. These you will often have to pay a little more for because they are expensive drugs.

Group C Drugs: These medications can reduce symptoms and improve daily functioning. This group includes painkillers and drugs to treat allergies, arthritis and indigestion. So these are drugs that you will have to pay a little more for because they are not essential for you to live.

Group D Drugs: These are drugs that can improve the psychological, emotional or physical condition. This group includes drugs for obesity, sexual dysfunction and acne. Many of these drugs are not covered by medicaid or medicare plans because they are seen as drugs that are not 100% necessary.

Health Plan With High Deductibles

If you have a health plan with a high deductible (HDHP), your pharmacy benefits are incorporated in your health plan. An HDHP has an integrated deductible, which means your out of pocket costs, for both medical and prescription drug coverage, apply to the same deductible. Health plans with high deductibles provide coverage for drugs that are specifically found in the Drug List. Not covered medications on the list do not apply to your deductible, but as with some plans you can get discount, which can be cheaper than the retail price.