Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

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.

Most Viewed FAQs
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 . . .

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 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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

Newest FAQs
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 . . .

My new Medicare Part D coverage is much more expensive than last year. Can I still change to another Medicare Part D prescription drug plan after the AEP closes?
Maybe, depending on your situation.  Most people cannot change their Medicare Part D plan coverage after the December 7th Annual Enrollment Period (AEP) deadline.  However, if you qualify f . . .

What do I need to know about my new Medicare card?
The Centers for Medicare and Medicaid Services (CMS) is mailing new Medicare cards to all 57.7 million Medicare beneficiaries (starting back in April 2018) and will continue through April 2019*. As . . .

Why are my medications costing more this year even though I didn't change Medicare Part D plans?
Annual Medicare plan changes and increases in your retail drug costs.  Medicare Part D prescription drug plans can (and usually do) change every year and even if you stayed with your same plan f . . .




Advertisement

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Advertisement

Browse Categories
Q&A of the Day
Help! Where Do I Start?
General Medicare Part D (PDPs and MAPDs)
Medicare Advantage Plans (MAPD)
Medicare Supplements or Medigap
Medicare Savings Account Plans (MSA)
Choosing a Medicare Plan
Star Ratings & Medicare Plan Quality
Medicare Part D Enrollment
ANOC: Annual Plan Changes
Changing Medicare Part D Plans
Medicare Enrollment Periods (IEP and AEP)
Special Enrollment Periods (SEPs)
Medicare Plan Disenrollment
Late-Enrollment Penalty (LEP)
Initial Deductible
Cost-sharing: What You Pay
Paying Your Premiums
Extra Help - LIS - Medicaid
IRMAA: Higher Incomes and Costs
Living with Your Medicare Part D Plan
Explanation of Benefits (EOB)
Pharmacies and Part D
Retail Drug Pricing
Straddle Claims
Understanding Your Formulary
Monthly Formulary Changes
Drug Usage Restrictions (QL, PA, ST)
Formulary Exceptions (Coverage Determinations)
Transition Fills
Coverage of Specific Drugs
Diabetes and Diabetic Coverage
The Donut Hole or Coverage Gap
Entering the Donut Hole
Donut Hole Discounts
Closing the Coverage Gap
Exiting the Donut Hole
Catastrophic Coverage
TrOOP and MOOP: Out of Pocket Costs
Specific Healthcare Coverage
Medicare Plan Providers
Traveling with Your Medicare plan
Moving and Medicare Part D
Drug Discount Cards
Using Part D with Other Drug Programs
VA and TRICARE Coverage
Employer Drug Coverage
General Medicare
New Medicare Cards
Medicare Part B
Medicare Set Aside Arrangements
Medicare and the ACA Marketplace
Online Tool Tips
Other Q1Medicare Tips and Questions
$250 Doughnut Hole Rebate (Only in 2010)


Find Prescription Discounts
Prescription Discounts are
easy as 1-2-3
  1. Locate lowest price drug and pharmacy
  2. Show card at pharmacy
  3. Get instant savings!
Your drug discount card is available to you at no cost.




Advertisement



Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.



Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.