@kathyjjb Even with government plans there are huge differences in coverage and co-pays depending on which you choose and the premiums you are willing/able to pay. We had the same plan for many years, but once on Medicare it was lousy. We changed to a large national plan, and it covers care much better. We almost always get a "yes" right away on medical care. I'm not sure what Tier 5 is, our pharmacy only lists through Tier 4. But you can petition for coverage to specialty drugs and sometimes get them. My brother has been successful, my sister-in-law has not . We think it might be who the Pharmacy Benefit Manager is in their separate states.