Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Sep, 22 2023 — Yes.  The Inflation Reduction Act (IRA) requires that a 30-day supply of any insulin product on a 2024 Medicare Part D prescriptions drug plans formulary is covered at a maximum $35 co-pay throu . . .

Sep, 22 2023 — Only in limited circumstances.  Usually a person cannot be enrolled in a Medicare Advantage plan that does not include drug coverage and then add a separate stand-alone Medicare Part D drug plan . . .

Sep, 22 2023 — You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap. Changes coming to the Medicare Part D Donut Hole. Spoiler Alert:  In 2025, the Inflation Re . . .

Sep, 22 2023 — A Medicare Advantage Health Maintenance Organization (HMO) plan is a Medicare approved health plan that provides you with access to a network of doctors and hospitals that coordinate your care, with a . . .

Sep, 22 2023 — A Preferred Provider Organization (PPO), is a type of Medicare Advantage plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong . . .

Sep, 16 2023 — Your Medicare Part D drug plan coverage is broken into four parts and you cross between these parts or phases of coverage based on the retail cost of your drugs or your total out-of-pocket spending.&n . . .

Sep, 10 2023 — Medicare should mail you a printed copy of the Medicare & You handbook each year with Medicare Part D and Medicare Advantage plans that are available in your area, unless you have opted out of rec . . .

Aug, 22 2023 — Our Q1Medicare® Formulary Browser includes formularies for all Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAPDs) - and is packed with valuable information about . . .

Aug, 21 2023 — RxMOOP is the maximum out-of-pocket spending limit for Medicare Part D prescription drugs. In 2024, RxMOOP will be the TrOOP threshold ($8,000). Starting in 2025, RxMOOP will be $2,000 and can change each year thereafter along with other Medicare Part D plan parameters.

Aug, 21 2023 — The federal government (i.e. tax payers) pays 80% of the retail drug cost, the Medicare Part D plan pays 15%, and the Medicare plan Member pays around 5% of the formulary drug's retail cost - but this will change in 2024 and beyond.

Aug, 21 2023 — Depending on the stage of your Medicare Part D coverage, a portion of your medication cost is paid by one or more of the following: You, Your Medicare plan, the brand-name drug man . . .

Aug, 19 2023 — Joining a Medicare drug plan is always your choice. You are not required to join a Medicare drug plan; it is optional. If you have CHAMPVA and you join a Medicare prescription drug plan, Medicare . . .

Aug, 19 2023 — Yes. You are permitted to disenroll from your Medicare Part D plan or Medicare Advantage plan during the Annual Open Enrollment Period (AEP) -- October 15th through December 7th -- or outside the AEP . . .

Aug, 19 2023 — Your Medicare plan can disenroll you from the Medicare plan, send your unpaid balance to a debt collection agency, require you to pay unpaid premiums if you ever wish to rejoin the plan, and you may also incur a late-enrollment penalty if you rejoin any Medicare drug plan

Aug, 19 2023 — Your Medicare Part D or Medicare Advantage plan can change every year and your Medicare plan is required to summarize any plan changes in your Annual Notice of Change letter (ANOC) that you should r . . .

Aug, 19 2023 — If a person stops paying their Medicare Part D or Medicare Advantage plan's monthly premium, the Centers for Medicare and Medicaid Services (CMS) allows the Medicare plan to disenroll the member from . . .

Aug, 19 2023 — Yes, you are responsible for the copayment of the purchase in the Initial Coverage phase plus cost-sharing on the amount of the purchase that exceeds your Medicare Part D plan's Initial Coverage Limit . . .

Aug, 18 2023 — Please contact your Medicare prescription drug plan's Member Services department (Medicare Part D or Medicare Advantage plan) directly to receive your replacement Member ID card. The toll-free numb . . .

Aug, 18 2023 — The complete list of Medicare abbreviations used by the Centers for Medicare and Medicaid Services (CMS) describing Medicare Part D prescription drug plans or Medicare Advantage plans is rather long ( . . .

Aug, 16 2023 — In the past, yes, but not in the future.  In the past, Catastrophic Coverage drug costs increased year-to-year -- but cost-sharing in the Catastrophic Coverage phase will end December 31, 2023. . . .

Aug, 08 2023 — Your (1) Member ID number, (2) Rx BIN, (3) PCN, and (4) Group ID (or Rx Group) number are the four numbers that uniquely identify you and your Medicare Part D prescription drug plan - and these four n . . .

Sep, 22 2023 — You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap. Changes coming to the Medicare Part D Donut Hole. Spoiler Alert:  In 2025, the Inflation Re . . .

Aug, 08 2023 — Medicare Part D prescription drug plans provide insurance coverage for your out-patient prescription drugs - and works just like any other type of insurance: (1)  Monthly premium.  You us . . .

Aug, 06 2023 — No.  Medicare Advantage plans are not the same as Medicare Supplements or Medigap policies. And here are a few key differences between the plans: Medigap policy design Medica . . .

Aug, 02 2023 — You can drop, disenroll, or cancel your Medicare Part D plan or Medicare Advantage plan coverage during the annual Open Enrollment Period - or a Special Enrollment Period - or you can be involuntarily disenrolled from your plan.

Jul, 06 2023 — A Special Enrollment Period (SEP) allows a Medicare beneficiary to join, switch, or drop their Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA or MAPD) outside of the ann . . .

May, 31 2023 — 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 . . .

Jul, 26 2023 — If you are eligible for Medicare and you don't have drug coverage through your employer, VA, or other source, additional prescription drug coverage is available to you through either: (1) a stand-a . . .

Aug, 02 2023 — If you did not enroll into a Medicare Part D prescription drug plan during your Initial Enrollment Period (IEP) and you did not have other creditable prescription drug coverage (like VA benefits or e . . .

Jul, 10 2023 — Yes.  Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage).  And, beginning Janua . . .

Aug, 02 2023 — 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 . . .

Jul, 20 2023 — To apply for the Medicare Part D Extra Help program: You can call the Social Security Administration about the Extra Help program at 1-800-772-1213, Monday through Friday between 7 am an . . .

Dec, 19 2022 — 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 quarterly Special Enrollment Period and can . . .

Jul, 10 2023 — Yes. In 2023, over 3,000 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium “Giveback” - or about 23,000 unique plan/county combinations of different Medicare Advantage plans - 2023 Part B give-backs can range up to $170.10.

Jul, 26 2023 — No Medicare and Humana are not the same. Humana is one of the largest private insurance companies that provides, along with other products, Medicare Advantage plans and Medicare Part D prescripti . . .

Jul, 16 2023 — TrOOP or your total out-of-pocket cost is the total amount you will spend in a year on your formulary drugs before exiting the Coverage Gap (or Donut Hole) and entering the Catastrophic Coverage of yo . . .

Jul, 07 2023 — A Medicare Advantage MAPD (or MA-PD) plan includes Medicare Part D prescription drug coverage and a Medicare Advantage MA plan does not include drug coverage. Both MAs and MAPDs provide coverage of your Medicare Part A (in-patient care) and Medicare Part B (out-patient care).

Jul, 08 2023 — If you are a person who has higher annual earnings, the Income-Related Monthly Adjustment Amount (or IRMAA) is an additional amount that you pay for your monthly Medicare Part D prescription drug plan . . .

May, 06 2023 — 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 . . .

Mar, 16 2023 — An HMO POS is a Health Maintenance Organization with a Point of Service Option. An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowi . . .