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 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 . . .

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.

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 . . .

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 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. And here are a few key differences between the plans: Medigap policy design Medica . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

Yes, you will be granted a Special Enrollment Period (SEP) from the start of the government-declared disaster and continuing 2 full months following the declared end date - or the announced disaster end date - whichever is later.

After enrolling in a Medicare Part D plan, the Medicare plan provider (such as WellCare or Humana or United Healthcare) will need about 10 business days to send you a a new Member "Welcome" package or . . .

No. A Medicare drug plan offering the Senior Savings Model provides various types and forms of insulin for a co-pay of $35 (or less) throughout the drug plan coverage until the final, Catastrophic Coverage phase where insulin will cost 5% of the retail price.

Maybe as early as December 2020.  On September 24, 2020, the U.S. Department of Health and Human Services (HHS) passed a final rule that, when effective, would allow states (such as Florida, Co . . .

Yes. 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) from October 15th through December 7th with coverage beginning January 1.

As part of the new CMS "Part D Senior Savings Model" (Model), about 30% of all 2021 stand-alone Medicare Part D plans (PDPs) and Medicare Advantage plans with drug coverage (MAPDs) will offer coverag . . .

The retail drug cost is counted toward the Donut Hole. So if your insulin has a $35 co-pay and has a retail cost of $957 - the $957 counts toward meeting your Initial Coverage Limit and entering the Coverage Gap or Donut Hole.

Yes. About 30% of 2021 Medicare prescription drug plans offer insulin at a maximum co-pay of $35 per month throughout the initial 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.

To learn more about low-cost insulin coverage, you can:Contact the Medicare drug plan's Member Services Department,Review the drug plan's Evidence of Coverage document,Speak with a Medicare representa . . .

Medicare Advantage plans provide coverage for Medicare Part A (in-patient, hospitalization), Medicare Part B (out-patient, doctor visits), and maybe Medicare Part D (prescription drug coverage from an . . .

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 benc . . .

As noted on the Medicare website, the Centers for Medicare and Medicaid Services (CMS) current guidance on coverage related to the novel corona virus COVID-19 is as follows: Medicare Part B an . . .

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.

Your monthly Medicare Part D premium can be broken into two parts: the Basic and Supplemental Premiums.  Although The “total premium” is really what is important to many people cons . . .

Yes.  Starting in 2021, Medicare Advantage plans will no longer have any health-related questions*.  So even if you are a Medicare beneficiary suffering from End-Stage Renal Disease (ESRD . . .

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 . . .