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 . . .

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.

You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap.As background, starting back in the 2011 Medicare Part D plan year, a discount or co-insurance (cos . . .

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 designMedicare Supplements (also called Medigap policies) work together with y . . .

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 . . .

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 . . .

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. However, a Medicare Advantage plans provide coverage for your Or . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

If you are Medicare-eligible and suffer from kidney failure or End-Stage Renal Disease (ESRD), you can join a 2021 Medicare Advantage plan during the annual Open Enrollment Period (AEP) that begins October 15th and continues through December 7th with coverage beginning January 1.

Yes. Some 2021 Medicare prescription drug plans may offer insulin at a maximum co-pay of $35 per month throughout all phases of your drug coverage (deductible, initial coverage, and the Donut Hole). But the $35 coverage depends on the plan and the specific type of insulin.

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.

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 . . .

Medicare Supplements (Medigap policies) work together with your original Medicare coverage, filling the "gaps" (deductibles, coinsurance, and copayments) in your Medicare Part A (in-patient or hospital insurance) and Part B (out-patient or physician insurance) coverage.

A PDP is a stand-alone Medicare Part D prescription drug plan (only offering drug coverage) and a MADP is a Medicare Advantage plan that includes prescription drug coverage along with Medicare Part A and Part B coverage - and maybe even additional or supplemental benefits.

Yes,  you can keep your Medicare Advantage plan and starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD - kidney failure) will be allowed to join any Medicare Advantage pl . . .

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

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 . . .

Yes.  If you are eligible for Medicare Part A and/or Medicare Part B (because you are 65 or have a disability), you are also eligible to enroll in a Medicare Part D prescription drug plan or Medi . . .

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

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 . . .

No, your Medicare coverage does not include Lifeline or any other Personal Emergency Response or Alert System as a benefit. However, it is possible that Medicaid or another state agency will cover . . .

Not exactly.  You will enter the Donut Hole based on the retail value of your formulary drug purchases - not just your co-payment (although a portion (or maybe all) of your co-payment will make u . . .

Yes, sometime in November.  If you purchase formulary medications with a total retail value of over $335 per month you will enter the 2020 Donut Hole.  You enter the 2020 Donut Hole or Cover . . .