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 ( . . .

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.

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 . . .

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 benef . . .

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. Even though Medicare plans sanctioned by the Centers for Medicare and Medicaid Services (CMS) are not allowed to accept new enrollment, Q1Medicare® shows “sanctioned” Medicare pl . . .

Medicare Part D Catastrophic Coverage is the fourth and final part of your Medicare Part D prescription drug plan coverage and is designed to help reduce the out-of-pocket spending for people with hig . . .

There are several reasons why you are paying more this year for your drugs even when you are in the same Medicare plan: Your drugs are no longer covered or covered at a higher price, you used a non-network or standard pharmacy, you lost Extra Help benefits, and more . . .

Yes.  You can estimate if - or when - you will enter Catastrophic Coverage based on your average monthly retail drug cost (only the retail price for your formulary drugs). For example, if you . . .

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.

The last Medicare plan enrollment application received before the end of the annual Open Enrollment Period or AEP (the AEP ends on December 7th) determines your Medicare Part D plan or Medicare A . . .

Our Q1Medicare PDP-Compare and MA-Compare tools allow you to compare annual Medicare changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MAs or M . . .

No, but you can choose a plan with lower retail drug prices.  Catastrophic Coverage cost-sharing is the same for all Medicare Part D plans - but, Medicare plans will have different retail drug . . .

Most likely, yes.   Usually Catastrophic Coverage drug costs increase year-to-year.In the Catastrophic Coverage phase, you will pay the greater of either 5% of the formulary drug's negoti . . .

What you pay in Catastrophic Coverage depends in your level of Extra Help.  If you are qualified for Medicare Part D Extra Help or the Low-Income Subsidy (LIS), you may have either full or partia . . .

Q1Medicare offers a series of online tools to help you review and analyze Medicare Part D plans and Medicare Advantage plans (including plan finders, drug finders, and cost calculators). This FAQ includes an overview of our Q1Medicare online tools - along with a few tool tips.

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 new Member "Welcome" package or a . . .

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 . . .

Medicare prescription drug coverage is insurance for your out-patient prescription drugs and you use your drug coverage like any other types of insurance: (1) Monthly premiumsYou usually pay a mo . . .

Many Medicare Part D prescription drug plans use a PBM or Pharmacy Benefit Manager to negotiate the plan's retail drug prices.  A Medicare drug plan's PBM might also establish pharmacy networks, . . .

A Medicare Part D PDP is a Medicare prescription drug plan that provides insurance coverage for a specific list of out-patient prescription drugs at participating pharmacies. Your prescription drug costs should be lower with a PDP.

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.