[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"aem-page-pages\u002Fdrug-tiers-initial-coverage-new-learning-hub":3},{"components":4,"disclaimers":85,"annoucementBar":92},[5,30,34,49],{"typename":6,"complianceLinks":7,"navigationLinks":8,"contextualEntryItems":7,"testimonials":7,"highlights":7,"accordions":7,"sideBarList":7,"hours":7,"heading":7,"firstLevelHeading":7,"secondLevelHeading":7,"hoursOfOperation":7,"ttyNumber":7,"iconPath":7,"bodyCopy":7,"imagePath":16,"alt":17,"images":7,"narrowCallOut":18,"lastPublishedDate":7,"copyright":7,"phoneNumber":7,"cmsId":7,"button":27,"primaryButton":7,"secondaryButton":7,"alertBar":7,"articleCardList":7,"iconTextCardList":7,"headline":7,"rowsList":7},"HeaderModel",null,[9,13],{"text":10,"target":11,"href":12,"parentText":7},"Learning Hub","_self","\u002Flearning-hub",{"text":14,"target":11,"href":15,"parentText":7},"About Us","\u002Fabout-us","https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FRelianceMALogo?fmt=png-alpha","Reliance Brand",{"firstLevelHeading":19,"secondLevelHeading":20,"hoursOfOperation":21,"ttyNumber":22,"iconPath":23},"Need help?","Call a licensed sales agent","Sun - Sat, 7 a.m. - 10 p.m. ET.","711",[24],{"alt":25,"imagePath":26},"Call Phone","https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FcallPhone?fmt=png-alpha",{"text":28,"colorClass":29},"Search plans","primary",{"typename":31,"complianceLinks":7,"navigationLinks":7,"contextualEntryItems":7,"testimonials":7,"highlights":7,"accordions":7,"sideBarList":7,"hours":7,"heading":7,"firstLevelHeading":7,"secondLevelHeading":7,"hoursOfOperation":7,"ttyNumber":7,"iconPath":7,"bodyCopy":32,"imagePath":7,"alt":7,"images":7,"narrowCallOut":7,"lastPublishedDate":7,"copyright":7,"phoneNumber":7,"cmsId":7,"button":7,"primaryButton":7,"secondaryButton":7,"alertBar":7,"articleCardList":7,"iconTextCardList":7,"headline":7,"rowsList":7},"TextBlockModel",{"html":33},"\u003Ch1>Medicare Advantage drug tiers and drug payment stages\u003C\u002Fh1>\n\u003Cp>Whether you have a \u003Ca data-ispdf=\"false\" data-iscta=\"false\" href=\"\u002Flearning-hub\u002Feligibility\u002Fmedicare-advantage-mapd.html\">Medicare Advantage Prescription Drug\u003C\u002Fa> plan (MAPD) or have simply chosen to enroll in Part D coverage on its own, it’s important to understand the costs and coverage stages of prescription drug benefits.  \u003C\u002Fp>\n\u003Cp>For most Part D plans, you’ll start in the Annual Deductible Stage, which is the part of your prescription drug coverage where you’re only required to pay for costs up to your deductible.\u003C\u002Fp>\n\u003Cp> \u003C\u002Fp>\n\u003Ch2>What is the initial coverage limit? \u003C\u002Fh2>\n\u003Cp>The initial coverage stage is the part of your Part D coverage where you’ll pay a copay or coinsurance for covered Part D prescriptions until you’ve reached a certain threshold. This is known as your out-of-pocket threshold for Part D drugs and, in 2026, the limit is $2,100.\u003C\u002Fp>\n\u003Cp>After reaching the $2,100 limit, you’ll enter a third Part D coverage stage called the Catastrophic Coverage stage. In this stage, you won’t have to pay for covered Part D drugs for the rest of the calendar year.\u003C\u002Fp>\n\u003Cp> \u003C\u002Fp>\n\u003Ch2>What are drug tiers?  \u003C\u002Fh2>\n\u003Cp>Another piece of Part D coverage that may impact your prescription drug costs is which tier your prescription falls under. Drug tiers represent the different drugs covered by your plan generally arranged by cost. So, a drug in a lower tier usually costs less than a drug in a higher tier.  \u003C\u002Fp>\n\u003Cp>One example of a drug tier list could look like this, but you should check your plan to see how it differs: \u003C\u002Fp>\n\u003Cul>\n\u003Cli>\u003Cb>Tier 1 - Preferred Generic\u003C\u002Fb>: Generic drugs that are available at the lowest cost share for the plan\u003C\u002Fli>\n\u003Cli>\u003Cb>Tier 2 - Generic\u003C\u002Fb>: Generic drugs that the plan offers at a higher cost to you than Tier 1 Preferred Generic drugs\u003C\u002Fli>\n\u003Cli>\u003Cb>Tier 3 - Preferred Brand\u003C\u002Fb>: Brand-name drugs that the plan offers at a lower cost to you than Tier 4 Non-Preferred drugs \u003C\u002Fli>\n\u003Cli>\u003Cb>Tier 4 - Non-Preferred Drug\u003C\u002Fb>: Generic or brand-name drugs that the plan offers at a higher cost to you than Tier 3 Preferred Brand-name drugs \u003C\u002Fli>\n\u003Cli>\u003Cb>Tier 5 - Specialty Tier\u003C\u002Fb>: High-cost drugs used to treat complex or chronic conditions.\u003C\u002Fli>\n\u003C\u002Ful>\n\u003Cp>You should check your plan’s formulary—their list of covered drugs—to see which of your prescriptions are under which tier.  \u003C\u002Fp>\n\u003Cp> \u003C\u002Fp>\n\u003Ch2>How do drug tiers impact my plan coverage?  \u003C\u002Fh2>\n\u003Cp>As long as your prescription is listed in your plan’s formulary, it will generally be covered. However, your coinsurance or copay for that drug may vary based on its tier. Sometimes, plans may change their formularies or move drugs to different tiers which may impact your expected costs.\u003C\u002Fp>\n\u003Cp>If your prescription is not listed in your plan’s formulary, then it may not be covered. Check your plan’s out-of-pocket benefit information to understand how much you may have to pay to continue that drug. If you and your doctor agree you should remain on a prescription not listed in your plan’s formulary, you can request a formulary exception, and you may be able to file an appeal if the request is denied.\u003C\u002Fp>\n\u003Cp> \u003C\u002Fp>\n\u003Ch2>Can I get help paying coinsurance during the initial coverage stage or for higher tier drugs?  \u003C\u002Fh2>\n\u003Cp>Yes, you can apply for \u003Ca data-ispdf=\"false\" data-iscta=\"false\" href=\"https:\u002F\u002Fsecure.ssa.gov\u002Fi1020\u002Fstart\">Extra Help\u003C\u002Fa>, a financial assistance program through Social Security (SSA) that helps pay for some of your prescription drug costs. You can apply for Extra Help online if you meet the following:  \u003C\u002Fp>\n\u003Cul>\n\u003Cli>You are entitled to Medicare Part A and\u002For enrolled in Part B \u003C\u002Fli>\n\u003Cli>You live in one of the 50 States or the District of Columbia \u003C\u002Fli>\n\u003Cli>Your combined savings, investments, and real estate are not worth more than $36,100, if you are married and living with your spouse  \u003C\u002Fli>\n\u003C\u002Ful>\n\u003Cp>OR \u003C\u002Fp>\n\u003Cul>\n\u003Cli>\u003Cp>$18,090 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.)  \u003C\u002Fp>\n\u003C\u002Fli>\n\u003C\u002Ful>\n\u003Cp>Please note that if you are enrolled in Medicare and also have Supplement Social Security (SSI) or \u003Ca data-ispdf=\"false\" data-iscta=\"false\" href=\"\u002Flearning-hub\u002Feligibility\u002Fwhat-is-dsnp.html\">Medicaid\u003C\u002Fa>, you will not need to apply for Extra Help because you will automatically qualify for Extra Help.\u003C\u002Fp>\n",{"typename":35,"complianceLinks":7,"navigationLinks":7,"contextualEntryItems":7,"testimonials":7,"highlights":7,"accordions":7,"sideBarList":7,"hours":7,"heading":36,"firstLevelHeading":7,"secondLevelHeading":7,"hoursOfOperation":7,"ttyNumber":7,"iconPath":7,"bodyCopy":7,"imagePath":7,"alt":7,"images":7,"narrowCallOut":7,"lastPublishedDate":7,"copyright":7,"phoneNumber":7,"cmsId":7,"button":7,"primaryButton":7,"secondaryButton":7,"alertBar":7,"articleCardList":37,"iconTextCardList":7,"headline":7,"rowsList":7},"SidebarArticleListContainerModel","More in Coverage Articles",[38,44],{"imagePath":39,"imageAltText":40,"ctaText":7,"ctaLink":7,"bodyCopy":7,"date":7,"eyebrow":41,"heading":42,"headingLink":43},"https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FAdobeStock_123212582-1?fmt=png-alpha","Pharmacist assisting senior man with medication","Article","Medicare Advantage drug tiers and drug payment stages","\u002Flearning-hub\u002Fcoverage\u002Fdrug-tiers-initial-coverage",{"imagePath":45,"imageAltText":46,"ctaText":7,"ctaLink":7,"bodyCopy":7,"date":7,"eyebrow":41,"heading":47,"headingLink":48},"https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FAbout?fmt=png-alpha","Senior woman using laptop on sofa","Planning for your out-of-pocket costs","\u002Flearning-hub\u002Fcoverage\u002Fplanning-for-out-of-pocket-costs",{"typename":50,"complianceLinks":51,"navigationLinks":58,"contextualEntryItems":7,"testimonials":7,"highlights":7,"accordions":7,"sideBarList":7,"hours":7,"heading":7,"firstLevelHeading":7,"secondLevelHeading":7,"hoursOfOperation":7,"ttyNumber":7,"iconPath":69,"bodyCopy":7,"imagePath":16,"alt":17,"images":7,"narrowCallOut":79,"lastPublishedDate":82,"copyright":83,"phoneNumber":7,"cmsId":84,"button":7,"primaryButton":7,"secondaryButton":7,"alertBar":7,"articleCardList":7,"iconTextCardList":7,"headline":7,"rowsList":7},"FooterModel",[52,55],{"typename":7,"text":53,"href":54,"target":11},"Privacy Policy","\u002Fprivacy-policy",{"typename":7,"text":56,"href":57,"target":11},"Washington MHMD Notice","\u002Fwashington-mhmd-notice",[59,62,66,68],{"text":60,"target":11,"href":61,"parentText":7},"Find Plans","#find-plans",{"text":63,"target":64,"href":65,"parentText":7},"Shop by benefit","_blank","\u002F",{"text":67,"target":64,"href":15,"parentText":7},"About Reliance",{"text":10,"target":64,"href":12,"parentText":7},[70,73,76],{"alt":71,"imagePath":72},"Facebook","https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002Ffacebook-2?fmt=png-alpha",{"alt":74,"imagePath":75},"Instagram","https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FInstagram?fmt=png-alpha",{"alt":77,"imagePath":78},"Twitter","https:\u002F\u002Fassets.humana.com\u002Fis\u002Fimage\u002Fhumana\u002FXTwitter?fmt=png-alpha",{"firstLevelHeading":19,"secondLevelHeading":20,"hoursOfOperation":21,"ttyNumber":22,"iconPath":80},[81],{"alt":25,"imagePath":26},"2026-10-01","© Reliance Medicare Advisors 2026","MULTIPLAN_GHHMQ6FEN_2027_WEB_V1_M",[86],{"disclaimerCopy":87,"dropdownTitle":89,"dropdownCopy":90},{"html":88},"\u003Cp>Innovative Financial Group is a licensed representative of Medicare Advantage organization and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. Reliance Medicare Advisors is owned and operated by Innovative Financial Group (IFG), a licensed insurance agency and Humana Inc. Reliance Medicare Advisors is not affiliated with or endorsed by any government agency.\u003C\u002Fp>\n\u003Cp>Reliance Medicare Advisors represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.\u003Cbr>\n\u003Cbr>\nWe do not offer every plan available in your area. Currently we represent ##carriers## organizations which offer ##products## products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.\u003C\u002Fp>\n\u003Cp>If you are turning 65, otherwise new to Medicare, losing benefits at work, moving, or have both Medicare and Medicaid you may be eligible. Other circumstances may qualify you as well.\u003Cbr>\n\u003Cbr>\nCosts, coverage, and benefits vary by location. These premiums and benefits may not be available on all Medicare Advantage plans. There may be no plan in your service area that includes all of these benefits.\u003Cbr>\n\u003Cbr>\nReliance Medicare Inc. and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate or exclude people because of their race, color, religion, gender, gender identity, sex, sexual orientation, age, disability, national origin, military status, veteran status, genetic information, ancestry, ethnicity, marital status, language, health status, or need for health services. We also provide free language interpreter services. See our full accessibility rights information, non-discrimination disclosure, and language options.\u003C\u002Fp>\n\u003Cp>For Aetna: The benefit(s) mentioned are part of special supplemental benefits for the chronically ill (SSBCI). SSBCI conditions include but are not limited to: hypertension, hyperlipidemia, diabetes, cardiovascular disorders, and chronic lung disorders. Eligibility is determined by whether you have a chronic condition associated with the benefit(s) and you meet all other criteria. Even if you have a listed chronic condition, you may not necessarily receive the benefit because other eligibility and coverage criteria may apply. Standards and conditions vary for each benefit. Contact us to confirm the specific SSBCI condition requirements for the benefit(s) for this plan and determine your eligibility.\u003C\u002Fp>\n\u003Cp>For Aetna: The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.\u003C\u002Fp>\n\u003Cp>Reliance Standard Life Insurance Company and its affiliated brand, Reliance Matrix, are not affiliated, authorized, endorsed by, or in any way connected with Reliance Medicare Advisors or any of its subsidiaries or affiliates, and are not involved in the services, products, or operations offered by Reliance Medicare Advisors.\u003C\u002Fp>\n\u003Cp>Not all plans offer all benefits mentioned. Benefits may vary by carrier and location. Deductibles, copays, and coinsurance may apply. Limitations and exclusions may apply. $0 premium plans are not available in all areas.\u003C\u002Fp>\n","Pre Zip Code",{"html":91},"\u003Cp>Innovative Financial Group is a licensed representative of Medicare Advantage organization and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. Reliance Medicare Advisors is owned and operated by Innovative Financial Group (IFG), a licensed insurance agency and Humana Inc. Reliance Medicare Advisors is not affiliated with or endorsed by any government agency.\u003C\u002Fp>\n\u003Cp>Reliance Medicare Advisors represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.\u003Cbr>\n\u003Cbr>\nWe do not offer every plan available in your area. Currently we represent 6 organizations which offer 3,398 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.\u003C\u002Fp>\n\u003Cp>If you are turning 65, otherwise new to Medicare, losing benefits at work, moving, or have both Medicare and Medicaid you may be eligible. Other circumstances may qualify you as well.\u003Cbr>\n\u003Cbr>\nCosts, coverage, and benefits vary by location. These premiums and benefits may not be available on all Medicare Advantage plans. There may be no plan in your service area that includes all of these benefits.\u003Cbr>\n\u003Cbr>\nReliance Medicare Inc. and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate or exclude people because of their race, color, religion, gender, gender identity, sex, sexual orientation, age, disability, national origin, military status, veteran status, genetic information, ancestry, ethnicity, marital status, language, health status, or need for health services. We also provide free language interpreter services. See our full accessibility rights information, non-discrimination disclosure, and language options.\u003C\u002Fp>\n\u003Cp>For Aetna: The benefit(s) mentioned are part of special supplemental benefits for the chronically ill (SSBCI). SSBCI conditions include but are not limited to: hypertension, hyperlipidemia, diabetes, cardiovascular disorders, and chronic lung disorders. Eligibility is determined by whether you have a chronic condition associated with the benefit(s) and you meet all other criteria. Even if you have a listed chronic condition, you may not necessarily receive the benefit because other eligibility and coverage criteria may apply. Standards and conditions vary for each benefit. Contact us to confirm the specific SSBCI condition requirements for the benefit(s) for this plan and determine your eligibility.\u003C\u002Fp>\n\u003Cp>For Aetna: The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.\u003C\u002Fp>\n\u003Cp>Reliance Standard Life Insurance Company and its affiliated brand, Reliance Matrix, are not affiliated, authorized, endorsed by, or in any way connected with Reliance Medicare Advisors or any of its subsidiaries or affiliates, and are not involved in the services, products, or operations offered by Reliance Medicare Advisors.\u003C\u002Fp>\n\u003Cp>Not all plans offer all benefits mentioned. Benefits may vary by carrier and location. Deductibles, copays, and coinsurance may apply. Limitations and exclusions may apply. $0 premium plans are not available in all areas.\u003C\u002Fp>\n",{"type":7,"bodyCopy":93,"iconPath":7,"tooltipTile":7},{"html":94},"\u003Cp>Reliance Medicare Advisors is an insurance agency with no government affiliation\u003C\u002Fp>\n"]