Q1Medicare.com FAQ: Q1FAQ.com/home.html

Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Browse the Most Viewed and Newest Medicare Part D FAQs
If you still have questions, please contact us through our Online Help Desk.

•	What is a Medicare Part D plan? Medicare Part D prescription drug plans provide insurance coverage for your out-patient prescription drugs - so Medicare Part D plans work just like any other types of insurance: (1) you usually pa . . .
•	I wish to drop my Medicare Part D prescription drug plan coverage - What should I do? In general, you can only drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the Annual Open Enrollment Period (AEP) -- that runs each year from Octob . . .
•	What is SLMB or a Specified Low Income Medicare Beneficiary? SLMB is one type of Medicare Savings Program for the "Specified Low - Income Medicare Beneficiary" and, according to the Centers for Medicare and Medicaid Services (CMS), SLMB is defined as: "A Medic . . .
•	How will I choose between a stand-alone Medicare Part D prescription drug plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)? 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) . . .
•	What are the Medicare Part D Special Enrollment Periods (SEP)? Usually, most seniors or other Medicare beneficiaries can only change their Medicare Part D or Medicare Advantage plan coverage during the annual Open Enrollment Period (AEP or Annual Enrollment Perio . . .
•	What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap? 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 . . .
•	I am considering changing my prescription drug coverage to the Humana Walmart-Preferred Rx Plan and I was wondering if I can only go to Walmart for my prescriptions? No, you do not have to use Walmart as your only pharmacy. The Humana Medicare Part D plans include over 50,000+ pharmacies in their pharmacy network. However, you may pay much more for your . . .
•	If I decide not to join any Medicare prescription drug plan, and I do not have any other prescription coverage, how long will I have to pay the late-enrollment premium penalty? Probably forever. The late-enrollment premium penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D prescription drug plan (o . . .
•	How does the Income-Related Monthly Adjustment Amount (or IRMAA) affect me and my Medicare plan premiums? 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 not . . .
•	What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money? 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 . . .

•	Is there a Special Enrollment Period for Medicare beneficiaries affected by a Major Disaster like a hurricane, typhoon, wildfire, flood, or earthquake? Yes. If you live in an area where the Federal Emergency Management Agency (FEMA) declared an emergency or major disaster, and you were not able to take advantage of an enrollment period (such as . . .
•	How much can the cost of a common generic drug vary between Medicare Part D plans and pharmacies? Medicare Part D plans (or their pharmaceutical benefit manager, PBM) set the retail prices for your formulary drugs at each standard and preferred network pharmacy. So retail prices can vary wee . . .
•	How will my Medicare Part D prescription drug plan actively fight the opioid epidemic? Starting in 2019, your Medicare Part D plan (MAPD or PDP) will implement a drug management program (or drug utilization management) to monitor and limit at-risk Medicare beneficiaries’ access to . . .
•	What is indication-based utilization management and how will it affect Medicare Part D plan members? Indication-based utilization management (or indication limitations) is a newly introduced type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan . . .
•	Do you have an online Formulary Browser that I can use to see the prescriptions covered by my Medicare Part D plan? Yes. We have our Formulary Browser online that includes every Medicare Part D and Medicare Advantage plan formulary or drug list and all formularies are formatted for alphabetical browsing. . . .
•	What discount will I receive for my tier 5 specialty drugs when I am in the Medicare Part D Donut Hole? It depends on the drug. The formulary drug tier (such as a Tier 5 Specialty Drug) does not affect your Donut Hole discount.Instead, the discount you receive on your medications when reaching the . . .
•	How do I get a refund for over-paid Medicare Part D premiums and co-payments? The Centers for Medicare and Medicaid Services (CMS) provides a "tip sheet" explaining how Medicare beneficiaries can receive a refund for their overpaid Medicare drug plan copayment and/or premiu . . .
•	I stopped working and now earn less than the IRMAA threshold, can I ask Social Security to reconsider my IRMAA premiums? Yes. If your income has changed and moved you to a lower income-related monthly adjustment amount (IRMAA) bracket, you should consider filing an appeal to have your IRMAA premiums reconsidered . . .
•	What is a multi-source drug? Multi-source drug is a term used by the Centers for Medicare and Medicaid Services (CMS or Medicare) distinguish between: Generic / Preferred Multi-Source Drug and Other Drugs . . .
•	Will my drug cost increase when I enter the Donut Hole? Maybe. As you move from your Initial Coverage Phase into the Coverage Gap, your savings -- or extra cost -- in the Donut Hole or Coverage Gap will depend on your Medicare Part D plan’s ini . . .