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Medicare.gov - Tutorial - Additional Medicare Plan Details

Medicare.gov - Tutorial - Additional Medicare Plan Details
Once a Medicare Part D drug plan is found, the user of the Medicare.gov Plan Finder can learn more about the Medicare plan details by clicking on the plan name in the plan overview.

Medicare.gov - Tutorial - Additional Medicare Plan Details

When we take a closer look, for example at the example plan in the screen shot, we see a summary of what we learned previously from the Medicare Plan Finder. Again we see the Medicare Part D plan contact information and then the projected annual prescription drug plan cost as compared to the cost if Mail Order is used.

Medicare.gov - Tutorial - Additional Plan Details
The bottom portion of the page shows a summary of medications and a bar chart illustrating the coverage phases of this Medicare Part D plan. In our example, we used a very expensive medication and you can see the retail cost of all the medications in the first column. In the next column of the chart, we see the prescription drug costs during the initial deductible phase. Since the retail costs are so high, we actually go through the initial deductible, initial coverage phase and the doughnut hole in the first month. The second month begins the catastrophic portion of the Medicare Part D plan and continues through the end of the year.

If the option is chosen to "Add More Drugs", you will be returned to the drug search form. When you have completed adding more drugs, you will again be asked about your pharmacy preferences and then arrive back at the Medicare plan overview or summary page.

Medicare.gov - Tutorial - Additional Plan Details

Now back to learning more about the plans. Medicare suggests that you choose a Medicare Part D plan based on the 3 "C’s": Cost, Coverage, and Convenience. We would add to this a fourth "C" that is important to many people: "Company". Everyone should ensure that their medications are covered (or at least their more expensive medications). Some people are looking at only cost — which Medicare plan will cost the least across the whole year. Some people will pay more annually for a Medicare Part D plan just to have no initial deductible ($0 deductible or first dollar coverage). Some people will pay more for their medications just to have a lower monthly premium. Some people only want the convenience of knowing that their local neighborhood pharmacy will accept their Medicare Part D plan so that they will not need to visit a chain pharmacy. Some people choose a Medicare Part D plan based on the underlying company — they select ABC Insurance Company, because they have always worked well with ABC Insurance Company.

Bottom Line: Everyone has a way to select a Medicare Part D prescription drug plan that is right for them. We usually suggest that you choose the Medicare Part D plan or Medicare Advantage plan that provides the most affordable health and prescription coverage and best service throughout the whole year.
Notice the Usage Management Restrictions

In the graphic above, you can see the medications are sorted by formulary or drug list tiers. Usually the higher tiers are reserved for more expensive or exotic medications, and this is true with this plan's Tier 5. Several of the medications also have certain formulary restrictions including Prior Authorization (where you need to receive written approval from the Medicare plan before filling a prescription, usually your prescribing doctor will help you with the Prior Authorization form) and Quantity Limits (you are allowed coverage for a certain amount of your prescription each month or other time limit). No medication in this example falls into having Step Therapy (you are asked to try another, less expensive medication before being allowed to use this prescription.).

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 PDPCompare.com and MACompare.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.