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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

I am new to Medicare. Where can I get an overview of the Medicare Part D program?
In general, Medicare Part D prescription drug plans provide insurance coverage for your out-patient prescription drugs - so Part D plans work just like other types of insurance: (1) you usually pay a ...

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)...

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 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...

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...

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 p...

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 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 ...

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...

I am on Medicaid and Medicare assigned me a Part D plan that does not cover one of my medications. What do I do?
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...

. Newest FAQs

If I am paying a Part D late-enrollment penalty and then become eligible for Extra Help, am I still responsible for paying the penalty?
No.  You are not responsible for a late-enrollment penalty (LEP) if you are now eligible for the Medicare Part D Extra Help or Low-Income Subsidy (LIS) program.And remember, you automatically qua...

Can I be assessed an Income Related Monthly Adjustment Amount (IRMAA) if I am enrolled in my employer's Medicare Part D plan?
Yes.  If your annual income (MAGI) exceeds certain limits - and you are enrolled in an employer-sponsored Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan with prescriptio...

What is the 5-star Special Enrollment Period?
If a Medicare Part D or Medicare Advantage plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period (SEP) for a once-a-year opportunity to switch from yo...

What is considered a non-formulary drug for purposes of a transition fill?
As noted by Medicare (the Centers for Medicare and Medicaid Services (CMS)) in the Medicare Prescription Drug Benefit Manual, Chapter 6 – Part D Drugs and Formulary Requirements, 30.4 - Transiti...

If I receive Medicare Part D Extra Help, will I enter the Donut Hole?
No.  If you are qualified for the Medicare Part D Extra Help program or Low-Income Subsidy (LIS), then you will never enter the Donut Hole or Coverage Gap and the cost of your prescriptions w...

Can I ask my Medicare Part D plan to move my medication to a lower-costing tier?
Maybe - depending on the drug.  Asking your Medicare Part D prescription drug plan to move a formulary medication to a lower-costing formulary tier (for example, from a Tier 4 medication to a Tie...

Is it possible to get an extension for my transition fill?
Yes - but only in specific circumstances. Your Medicare Part D plan may provide you with a transition fill extension. However, such an extension is provided only on a case-by-case basis in exception...

Will I pay the "average negotiated retail price" at my local pharmacy?
Maybe.  We show the "average negotiated retail drug price" in our Drug Finder (www.Q1Rx.com) and this means that these retail drug prices are the average price across all pharmacies in the plan&#...

Looking for our online Medicare plan tools? A few tips on using our Q1Medicare.com dedicated landing pages
We have a series of Dedicated Landing Pages that help get you directly to our online Medicare plan tools and content.  You can use these links to find your way directly to the Q1Medicare.com feat...

What happens when a person is "crosswalked" to another Medicare Part D plan?
The term "crosswalked" refers to being automatically transferred to another Medicare Part D plan or Medicare Advantage plan when your Medicare plan changes names or changes Contract ID/Plan IDs or is ...

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The Late-Enrollment Penalty (LEP)
Cost-sharing: What you pay
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Extra Help - LIS - Medicaid
IRMAA: Higher Incomes and Costs
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Transition Fills
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The Donut Hole or Coverage Gap
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Donut Hole Discounts
Closing the Coverage Gap
Exiting the Donut Hole
TrOOP and MOOP: Out of Pocket Costs
Traveling with your Medicare plan
Moving and Medicare Part D
Drug Discount Cards
Using Part D with other Drug programs
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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.