Prescription coverage

Changes to your Medicare prescription (Part D) benefit for 2027

Here are some changes to your individual Medicare Advantage prescription benefit beginning January 1, 2027:

• The annual out of pocket maximum is $2,400 (in 2026 it was $2,100).
• There are drug coverage changes including tiering, copay and deductible changes.

Prescription drug stages

The Medicare Part D structure consists of three stages:

Stage 1 - If your plan has a deductible, you need to pay that deductible to enter the next stage of coverage.

Stage 2 - This coverage stage occurs after the deductible is met. You will have a copay or coinsurance until your $2,400 out-of-pocket maximum is reached. This stage is where you will spend the majority of your prescription drug costs, and it covers both generic and brand-name drugs.

Stage 3 – You’ve reached $2,400 in out-of-pocket costs, including your payments and those of others who pay on your behalf. This stage is called the catastrophic phase of coverage. You will pay nothing for covered drugs for the remainder of the coverage year. 

Tools to help you find and compare prescription drugs covered by Medicare and benefits

To find out if your Medicare plan covers your prescription drug, please check our formulary (drug list).

Medicare formulary drug list

Your Medicare Part B (medical insurance) does cover some outpatient prescription drugs under specific conditions. Learn more at medicare.gov. Some Part B prescription drugs have a step therapy requirement. For more information, view our Medicare Part B Prior Authorization and Step Therapy Criteria.

We make every effort to ensure you receive safe, appropriate drugs. We have Medication Therapy Management and Utilization Management programs in place to identify potential problems and resolve them before they become an issue.

Compare prescription drug benefits and costs

If your medication is covered by your Medicare insurance, you can use our online tool, Express Scripts, to compare prescription drug benefits across different plans. You can also compare plan options against current medication costs to choose the plan that best meets your needs. To use Express Scripts and see if your medication is covered, select your plan below:

Medicare Advantage Plans

• HAP Medicare Connect (HMO)
• Henry Ford Select (HMO)
• HAP Medicare Superior (HMO)
• HAP Medicare MedicalAccess (HMO)
• HAP Senior Plus Henry Ford Tiered Access (HMO)
• HAP Senior Plus (HMO-POS)
• HAP Member Assist (PPO)
• HAP Medicare Prime (PPO)
• HAP Medicare Explore (PPO)
• HAP Senior Plus (PPO)
• HAP Medicare Complete Duals (HMO D-SNP)
• HAP Medicare Complete Assist (PPO D-SNP)
• HAP Medicare Diabetes and Heart (HMO C-SNP)

After selecting your plan above, select a plan year and plan. The tool does the rest. You'll be able to compare annual costs across plans, check medication prices, see what pharmacies are in-network and find out what medications are covered.

Get help paying for prescriptions

If you have limited income, you may qualify for Extra Help with prescription drug coverage costs through the Medicare Part D subsidy. If you qualify and enroll in one of our Medicare Advantage plans with prescription drug coverage, you may pay less for copays and premiums.

Help paying for prescriptions

Fill a prescription

Members can get brand-name and generic prescription drugs at any of the 2,000 pharmacies in our network.

In-network pharmacies
 

Important message about what you pay for vaccines

Our plans cover most Part D vaccines at no cost to you (even if you haven’t paid your deductible). For more information, call member services at (800) 422-4641 (TTY: 711). You can reach us Monday - Friday from 8 a.m. to 7 p.m.

Important message about what you pay for insulin 

You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on (even if you haven’t paid your deductible).