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Tips from the Centers for Medicare and Medicaid (CMS)

The following documents are available for download as a service to you. These documents are provided by the Centers for Medicare and Medicaid (CMS)

Bridging the Coverage Gap

If your drug plan has a coverage gap, here are some ways you can avoid or delay entering the gap, and continue to save money on drug costs while in the gap . . .

Download the "Bridging the Coverage Gap" Tips document
Closing the Coverage Gap

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 Medicare beneficiaries once they entered the Coverage Gap (or Donut Hole / Doughnut Hole) portion of their stand-alone Medicare Part D prescription drug plan (PDP) (or Medicare Advantage plan that included prescription drug coverage (MAPD)). Over the years, the Donut Hole discount increased providing more coverage formulary drug purchases in Donut Hole.

Now if you reach the Donut Hole phase of your Medicare prescription drug plan and your medication is on your plan's formulary and you are not receiving financial Extra Help (LIS), you receive a 75% discount on all formulary drugs. (You pay 25% of your plan's negotiated retail cost for any formulary drug purchases made while in the Coverage Gap.)

Also see: But isn’t the Coverage Gap (Donut Hole) closed?

Premium Withhold Refund Issue

Please note: If you received a reimbursement of your Medicare Part D premiums and then a letter from the government explaining the mistake and asking that you return the money - you may want to explore your options before returning the reimbursement. The repayment issue is not resolved and you may actually be entitled to keep the refund. For further information, please contact CMS (1-866-292-8080) and ask about your rights and obligations with respect to repaying the erroneous refund. (This topic was highlighted in our September 2006 newsletter.)

In early August, due to a Medicare processing error, roughly 230,000 people received refunds for their drug plan or Medicare Advantage plan premiums in their August 2006 Social Security benefit checks or direct deposits.

People whose plan premiums were mistakenly refunded will not loose any of their Medicare coverage. However, Medicare needs to re-collect the money that was refunded in error.

The document below details the steps that should be taken. It includes the appropriate Medicare telephone numbers and mailing addresses.

As noted on the CMS website:

Date 08/28/2006
Subject CMS Takes Steps to Correct Erroneous Plan Premium Refunds

As a follow-up to our notification from last week regarding the erroneous plan premium refunds, the Centers for Medicare & Medicaid Services (CMS) is sending a letter to the approximately 230,000 people who mistakenly received refunds for their drug plan or Medicare Advantage plan premiums in their August 2006 Social Security benefit payments either via checks or direct deposits. This letter explains the error and provides beneficiaries with options for returning the overpayment. In addition, CMS has issued a Partner Tip Sheet (available through the link below) that also explains the steps that people can take right now to help correct this situation.

In brief, CMS will provide a range of options for assuring that the refunds go to the intended purpose of paying beneficiary premiums while minimizing inconvenience for beneficiaries. Beneficiaries will have the option to return the premium payments by returning the voided check, sending a personal check, or authorizing an electronic debit from their account. We intend to continue to do all we can to ensure that beneficiaries' Social Security payments reflect accurate premium adjustments.

Please keep in mind that the Social Security withholding is working smoothly for the vast majority of the 4.7 million beneficiaries who are using the premium payment option and the people who had their plan premiums mistakenly refunded will not lose any of their Medicare coverage.

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • 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.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.