Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Medicare Part D prescription drug plans provide insurance coverage for out-patient prescription drugs.A Medicare Part D plan works just like any other types of insurance: (1) you usually pay a mont . . .

You can drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the annual Open Enrollment Period - or a Special Enrollment Period - or you can be involuntarily disenrolled from your plan.

Starting back in the 2011 Medicare Part D plan year, a discount or co-insurance (cost-sharing) was introduced to reduce the cost of generic and brand-name prescription drugs purchased by non-LIS . . .

Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs) . . .

A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD) outside of the ann . . .

The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare to help low-income Medicare beneficiaries pay their Medicare . . .

If you did not enroll into a Medicare Part D prescription drug plan during your Initial Enrollment Period (IEP) and you did not have other creditable prescription coverage (like VA or employer benefit . . .

No.  Medicare Advantage plans are not the same as Medicare Supplements or Medigap policies. Medigap policy design.  Medicare Supplements (also called Medigap policies) work togethe . . .

If you are paying IRMAA (the Income-Related Monthly Adjustment Amount), this means that, based on your income, you will pay higher premiums for your Medicare Part B and Medicare Part D coverage. As . . .

To apply for the Medicare Part D Extra Help program: You can call the Social Security Administration about the Extra Help program at 1-800-772-1213, Monday through Friday between 7 am an . . .

Your (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan - and these four n . . .

You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients both receive a continuous Special Enrollment Period and ca . . .

Yes.  Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage).  However, coverage (a . . .

Yes!  A stand-alone Medicare Part D prescription drug plan (or PDP) only provides out-patient prescription drug coverage. Alternatively, Medicare Advantage plans provide coverage for your . . .

If you are a person who has higher annual earnings, the Income-Related Monthly Adjustment Amount (or IRMAA) is an additional amount that you pay for your monthly Medicare Part D prescription drug plan . . .

A Medicare Advantage MAPD includes Medicare Part D prescription drug coverage and a Medicare Advantage MA plan does not include drug coverage.In general, a Medicare Advantage plan is a health plan opt . . .

An HMO POS is a Health Maintenance Organization with a Point of Service Option. An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowi . . .

No Medicare and Humana are not the same. Humana is one of the largest private insurance companies that provides, along with other products, Medicare Advantage plans and Medicare Part D prescripti . . .

TrOOP or your total out-of-pocket cost is the total amount you will spend in a year on your formulary drugs before exiting the Coverage Gap (or Donut Hole) and entering the Catastrophic Coverage of yo . . .

You can call the Social Security Administration to report the death of a Medicare beneficiary at 1-800-772-1213 (TTY 1-800-325-0778).As noted on the Social Security Administration site:"You cannot re . . .

There are several reasons why you are still paying a monthly Medicare Part D plan premium even though you are qualified for Medicaid or Extra Help benefits: (1) Your plan does not meet the benchm . . .

Below are links to health departments in all states and Washington, DC, the 8 US territories, and the freely associated states. 50 U.S. State Health Department Websites Alabama Depa . . .

Yes,  you can keep your Medicare Advantage plan.Medicare states, [i]f you have ESRD, you'll usually get your health care through Original Medicare. You can only join a Medicare Advantage Plan in . . .

Maybe.  The Centers for Medicare and Medicaid Services (CMS) has recognized that some insulin delivery systems may now be covered by a Medicare Part D prescription drug plan when the devices are . . .

Yes - but only some plans in certain areas.  Medicare Advantage plans change plan coverage each year, and depending on the estimated cost for each Medicare Advantage plan member, some $0 premium . . .

Your Medicare Part D late-enrollment penalty is calculated as the number of months you are without some form of "creditable" prescription drug coverage multiplied by 1% the annual base Medicare Part D . . .

You enter the Donut Hole when the retail cost of your formulary drug purchases exceeds your plan's Initial Coverage Limit (ICL) and you exit your Medicare Part D drug plan's the Initial Coverage Phase . . .

The Medicare Part D Extra Help or Low-Income Subsidy (LIS) program helps people with limited financial resources pay for their Medicare Part D prescription drug coverage. If you receive Medicare Pa . . .

The Qualifying Individual (QI) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare.  QI helps low-income Medicare beneficiaries pay their Medicare P . . .

Yes, in some situations, limited chiropractic services are covered by Medicare.According to the Medicare.gov website, your "Medicare Part B (Medical Insurance) covers manual manipulation of the spine . . .

If your formulary medications have a total retail cost over $335 each month, you will exceed your Medicare Part D plan's $4,020 Initial Coverage Limit and enter the Donut Hole or Coverage Gap sometime in 2020.

If your Medigap policy is type C, D, E, F, G, H, I, J, M or N; your plan may offer additional coverage for health care services or supplies that you get outside the U.S.

As we move toward the warmer months of the year, we need to think more about the combination of sun, heat, and humidity and protecting ourselves during these longer, warmer days.

Even with the 75% Donut Hole discount, you may find that you are paying more for your formulary drugs when you leave your Initial Coverage Phase and enter the Coverage Gap - depending on whether or not you were paying less than 25% of retail in your Initial Coverage Phase.

Special Supplemental Benefits for the Chronically Ill or non-primarily health related Supplemental Benefits are an additional type of coverage that Medicare Advantage plans can offer plan members wit . . .

After you spend a certain amount of money on your prescription drugs during the year (for example, over $6,350 out-of-pocket in 2020), you will meet your Medicare Part D prescription drug plan's out-o . . .

Yes.  Our Medicare Part D Donut Hole Calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and . . .

Your monthly Medicare Part D IRMAA (Income-Related Monthly Adjustment Amount) charges will be deducted automatically from your Social Security check, or . . .. . . If the amount of your Social Securit . . .

Probably.  Each Medicare Part D prescription drug plan (PDP or MAPD) has a national pharmacy network that includes 50,000 to 60,000+ pharmacies and both "preferred" and "standard" pharmacies ar . . .

The Medicare Advantage Open Enrollment Period (MA-OEP) is another enrollment period allowing people currently enrolled in a Medicare Advantage plan (MAPD or MA) an opportunity to change Medicare Advan . . .