Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Jun, 11 2025 — Medicare Part D plans are categorized as defined standard (DS), actuarially equivalent (AE) standard, or basic alternative (BA) - and benefits are actuarially equivalent to the CMS defined standard Part D benefit. Enhanced alternative (EA) plans exceed defined standard coverage.

Jun, 11 2025 — Originally, the policy established that Medicare beneficiaries can purchase drugs at lower pharmacy prices without using their Medicare drug plan (during a time when the beneficiary pays 100% of the cost) - and ask the plan to add the purchase to their total out-of-pocket costs.

Jun, 11 2025 — When the cost of your medication covers two parts of your Medicare Part D plan, you have a “straddle claim” where your drug costs are split over two different phases of your drug plan cove . . .

Jun, 11 2025 — Yes. If you use a Special Enrollment Period (SEP) to change Medicare drug plans during the year, you will find that both the total retail value of your drug purchases and the total value of your out-of-pocket spending (TrOOP) transfer to your new Part D plan.

Jun, 11 2025 — Probably Not.  Although you can always ask your Medicare Part D plan for more coverage information, the Medicare Part D program does not anticipate coverage for medications purchased outside of t . . .

Jun, 10 2025 — Your monthly Medicare Part D premium can be broken into two parts: the Basic and Supplemental premiums - and Medicare provides the technical definitions of Total Premium, Basic Premium, and Supplement . . .

Jun, 09 2025 — Besides the usual considerations of cost, convenience, coverage, etc., some people choose a Medicare Part D plan for less obvious reasons.  We have heard from many people who are enrolling in . . .

Jun, 09 2025 — A Generic Drug, according to the Centers for Medicare and Medicaid (CMS) is defined as: A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually c . . .

Jun, 09 2025 — If your drug plan has both preferred and standard network pharmacies, you probably will pay less for your formulary prescription drugs when using one of your plan's preferred network pharmacies.

Jun, 09 2025 — Yes.  If you have Veterans Administration (VA) drug coverage, you can also join a Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan that includes drug coverage (MAPD) - and . . .

Jun, 09 2025 — If you lose your Medicare Part D coverage or are involuntarily disenrolled from your Medicare plan: You may no longer have any prescription drug coverage until you join another Medicare plan - . . .

Jun, 09 2025 — Yes.  Your Explanation of Benefits (EOB) is a monthly statement that your Medicare Part D prescription drug plan (or Medicare Advantage plan) will send you to explain your year-to-date Medicare . . .

Jun, 09 2025 — Choose a Medicare Part D (PDP) or Medicare Advantage (MA or MAPD) plan that provides the most cost-effective coverage for your medication and healthcare needs. However, the more complicated answer . . .

Jun, 09 2025 — You can review your plan's Annual Notice of Change letter (ANOC) that your Medicare plan will send you in late-September or early-October of every year. You can also use our https://PDP-Compare.com or https://MA-Compare.com tools to see annual changes in Medicare plan copays.

Jun, 09 2025 — No - unless the non-Part D drug is used for a medically-accepted indication. A note about a one month's Transition Fill or Temporary Supply of your Part D drugs:  During the first 90 days of y . . .

Jun, 07 2025 — Only in very limited situations.   In 2016, the Centers for Medicare and Medicaid Services (CMS) updated their Prescription Drug Manual and added some guidance for the exceptional circumstanc . . .

Jun, 07 2025 — In general, "creditable" prescription drug coverage is considered by Medicare to be "as generous as, or more generous than" (or at least as good as) standard Medicare Part D prescription drug coverage . . .

Jun, 07 2025 — Our Q1Medicare® PDP-Compare and MA-Compare tools allow you to compare annual Medicare changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MA . . .

Jun, 07 2025 — Probably not.  In most cases, if your Employer (or Union) healthcare plan includes drug coverage, your plan will NOT work together with a Medicare Part D plan - and you probably will NOT be able . . .

Jun, 07 2025 — Indication-based utilization management (or indication limitations) is a type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan's prior authoriz . . .

Jan, 26 2025 — 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 . . .

Jan, 05 2025 — Medicare Part D prescription drug plans provide insurance coverage for the out-patient prescription drugs covered by your drug plan - and works just like any other type of insurance: (1)  You . . .

Oct, 28 2024 — 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 . . .

Feb, 11 2025 — 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.

Jan, 19 2025 — 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 . . .

Mar, 12 2025 — 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 . . .

Feb, 26 2025 — 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, 04 2024 — 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 . . .

Nov, 14 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 . . .

Nov, 14 2024 — 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 . . .

Feb, 07 2025 — 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 . . .

Mar, 19 2025 — TrOOP or your true out-of-pocket spending is the amount you - or others on your behalf - spend toward your Medicare Part D plan's formulary Part D drugs. For example, if you purchase a $100 formulary . . .

Oct, 13 2024 — Yes. In 2025, over 3,000 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium rebate or giveback - 2025 Part B rebates can range from $0.10 up to $174.70.

Jan, 27 2025 — You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients may be able to use the Dual-Eligible Special Enrollment P . . .

Oct, 27 2024 — 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).

Nov, 14 2024 — If you are a Medicare beneficiary with higher annual earnings, you may be assessed an Income-Related Monthly Adjustment Amount (or IRMAA) which is an additional amount that you pay together with your . . .

Mar, 12 2025 — SLMB or "Specified Low-Income Medicare Beneficiary" is a person qualifying for a type of Medicare Savings Program (MSP) designed for people with limited monthly income and resources (assets). Quali . . .

Mar, 06 2024 — 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 . . .

Mar, 17 2025 — Yes.  A stand-alone Medicare Part D prescription drug plan (or PDP) only provides out-patient prescription drug coverage. However, a Medicare Advantage plans provide coverage for your Origina . . .

Jun, 06 2025 — Within 3 months.  Depending on any administrative issues, you can usually expect your Social Security check premium deductions to begin within 3 months after the start of a new Medicare plan year . . .