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Q1Medicare.com - Latest Medicare News

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2018 Federal Poverty Level Guidelines (FPL): 2018 LIS Qualifications and Benefits
Update: See the 2019 Federal Poverty Level (FPL) Guidelines and 2019/2020 LIS (Extra Help) requirements. The 2018 Federal Poverty Level (FPL) Guidelines determine the income level requirements for pe . . .

What does the letter after my Medicare number mean?
March 2018 Update - Medicare Cards are Changing - New Card, Same BenefitsThe Centers for Medicare and Medicaid Services (CMS) is mailing new Medicare cards starting April 2018 and continuing through A . . .

2019 IRMAA: 5% decrease in Medicare Part D IRMAA for individual earning incomes between $85,000 - $500,000 and couples earning $170,000 - $750,000.
Since 2011, people with Medicare who earn over $85,000 have been paying an additional monthly premium or Income-Related Monthly Adjustment Amount (IRMAA) for their Medicare Part D prescription drug p . . .

2019 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006
The Centers for Medicare and Medicaid Services (CMS) released the 2019 low-income premium subsidy amounts (or Benchmark) for Medicare Part D plans on July 31, 2018, and in 2019, thirteen (13) regions . . .

Changes are coming for 2019 Medicare Part D plans: A few highlights from the 2019 final CMS Call Letter and Final Rule
Seniors, Medicare plan providers, and caregivers can expect a few changes in the 2019 Medicare Part D program.  Below are a few highlights from the final 2019 Call Letter and a 1,156 page Medic . . .

Understanding the 2018 Medicare Part D Coverage Gap or Donut Hole
The Donut Hole or Coverage Gap is a term used to describe a gap or pause in your Medicare Part D prescription drug plan or Medicare Advantage plan coverage where, prior to 2011, you were 100% respon . . .

Does Medicare cover Vitamin B-12 injections (B-12 shots)?
Medicare Part D prescription drug plans expressly excludes coverage for vitamins - although some Medicare plans do cover "excluded" drugs such as B-12 vitamin injections as "Bonus" or Supplemental dru . . .

SilverScript Medicare Part D Pharmacy and Formulary Search
Question: What drug stores accept the SilverScript Medicare Part D prescription drug plans? Most Medicare Part D plans are accepted by over 50,000+ pharmacies across the country. However, if you . . .

2018 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006
Update   See: 2019 State Low-Income Subsidy Benchmark Premium Amounts - with a comparison of benchmark changes since 2006 at https://Q1News.com/703.html. The Centers for Medicare and Medicai . . .

Chart of 2017 BIN and PCN values for each Medicare Part D prescription drug plan (part 1 of 3)
The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2017 Medicare Part D plan sponsor.  Please note, the data below is Part 1 of 3, wi . . .

Latest News
April 2019 Drug List Updates: Twenty-four (24) new generic drugs added to many Medicare Part D plan formularies.
As you may know, Medicare Part D prescription drug plans update their plan formularies (drug lists) throughout the plan year and the April 2019 Medicare Part D formulary updates included 42 new dru . . .

April 2019 Formularies Update: Seventy (70) Medications Added to Medicare Plan Drug Lists
The April 2019 Medicare Part D plan formulary (drug lists) data includes the addition of 70 new National Drug Codes (NDCs) to the Medicare Part D program.  These NDCs represent 42 different drugs . . .

Spring 2019 Formulary Changes to the Top Medicare Drugs
The Spring 2019 Medicare Part D plan formulary (or drug list) updates included 198 new drug codes or NDCs representing 137 different medications in the March 2019 dataset and 70 new drug codes or NDCs . . .

March 2019 Drug List Updates: Seventy-two (72) new generic drugs added to many Medicare Part D plan formularies.
As you may know, Medicare Part D prescription drug plans update their plan formularies (drug lists) throughout the plan year and the March 2019 Medicare Part D formulary updates included 198 new dr . . .

March 2019 Formularies Update: One Hundred and Ninety-Eight (198) Medications Added to Medicare Plan Drug Lists
The March 2019 Medicare Part D plan formulary (drug lists) data includes the addition of 198 new National Drug Codes (NDCs) to the Medicare Part D program.  These NDCs represent 137 different dru . . .

Medicare Part D 2020: CMS releases the finalized 2020 Medicare Part D standard drug plan coverage parameters
On April 1st, the Centers for Medicare and Medicaid Services (CMS) released the 2020 Announcement and Final Call Letter that includes the defined standard benefits parameters for 2020 Medicare Part . . .

If I am in the 2019 Donut Hole and get a 75% discount on my brand-name drugs, what percent of my purchase counts toward exiting the Donut Hole?
95% of your brand-name drug's retail cost is counted toward exiting the 2019 Donut Hole. If your monthly purchases of formulary medications consistently have a retail value of over $319, you wil . . .

12 reasons why you may be paying more for your 2019 Medicare prescription drug coverage
Medicare Part D prescription drug plans (PDPs and MAPDs) can change every year and even if you stayed with your same plan from 2018, there are a number of possible reasons why you may be paying more . . .

2019 Federal Poverty Level Guidelines (FPL): 2019/2020 LIS Qualifications and Benefits
The 2019 Federal Poverty Level (FPL) Guidelines determine the income level requirements for people applying for the Medicare Part D Low-Income Subsidy (LIS) program, also known as the "Extra Help" pro . . .

Preview Medicare Part D 2020: CMS releases the proposed 2020 Medicare Part D standard drug plan coverage parameters
On January 30th, the Centers for Medicare and Medicaid Services (CMS) released Part II of the 2020 Advance Notice and Draft Call Letter that included proposed defined standard benefits for 2020 Med . . .




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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.