Medicare Part D questions and answers
168 answers across 42 topics, covering enrollment periods, Extra Help and the Low-Income Subsidy, IRMAA, formularies and appeals.
ANOC: Annual plan changes (2)
Archive (1)
Archive: Closing the Coverage Gap (1)
Archive: Donut Hole Discounts (1)
Archive: Entering the Donut Hole (1)
Archive: The Donut Hole or Coverage Gap (1)
- Archive: What is the Donut Hole or Coverage Gap?Aug 07, 2024
Changing Medicare Part D plans (2)
Choosing a Medicare plan (1)
Cost-sharing: What You Pay (5)
- The Medicare Prescription Payment Plan: Like 0% financing for your formulary Part D drug purchases.Jan 21, 2026
- What is my Medicare Part D plan's Initial Coverage Phase?Feb 22, 2025
- What is coinsurance?Dec 04, 2024
- How will I know if my Medicare drug plan's drug copayments will change next year?Jun 09, 2025
- What is Medicare Part D or Medicare Advantage plan cost-sharing?Jun 02, 2025
Coverage of specific drugs (1)
Drug Usage Restrictions (QL, PA, ST) (2)
Employer drug coverage (3)
- What is the difference between creditable and non-creditable Employer Retiree Drug Coverage?Jun 07, 2025
- Is there a Special Enrollment Period (SEP) available to join or leave an Employer or Union Group Health Plan (EGHP)?Apr 14, 2025
- What is considered "creditable" drug coverage for purposes of the Medicare Part D late-enrollment penalty?Jun 07, 2025
Explanation of Benefits (EOB) (1)
Formulary Exceptions (Coverage Determinations) (7)
- What is a Medicare Part D Formulary Exception?Jan 03, 2025
- Can my Medicare Part D prescription drug plan drop medications from the plan's drug list at any time?Apr 08, 2025
- Five things you can do when your Medicare drug plan drops your brand-name drug during the year.Jun 06, 2025
- If my Medicare drug plan agrees to cover a non-formulary drug, can I also ask the plan to move the same drug to a lower-costing formulary tier?May 03, 2025
- Can I ask my Part D plan to move my medication to a less expensive drug tier?Feb 03, 2025
- Will my Medicare drug plan grant a formulary exception to lower the cost of my Tier 5 Specialty Drug?Apr 25, 2026
- What will I pay for my medication if my Medicare plan agrees to cover a non-formulary drug?Nov 14, 2024
General Medicare (1)
- What is Medicare Part A (Hospital Insurance)?Jun 12, 2024
General Medicare Part D (PDPs and MAPDs) (3)
Help! Where Do I Start? (5)
- What is coinsurance for Medicare Part D plans?Jun 06, 2025
- Where can I see my Medicare plan's cost-sharing information?Jun 24, 2024
- Can I use my prescription drug coverage before receiving my new Medicare plan's Member ID card?Jun 03, 2025
- What is Medicare prescription drug coverage?Aug 07, 2026
- What should I do if I enrolled in a new Medicare Part D plan and still have not heard anything from my plan?Dec 09, 2025
Insulin and diabetic supplies (1)
IRMAA: Higher incomes and costs (13)
- What is the Income-Related Monthly Adjustment Amount (IRMAA)?Nov 15, 2025
- How does the Income-Related Monthly Adjustment Amount (or IRMAA) affect me and my Medicare plan premiums?Nov 15, 2025
- How does the Social Security Administration (SSA) determine whether I pay a higher Medicare Part B and Medicare Part D premium?Nov 15, 2025
- Which tax return does the Social Security Administration use to determine my Medicare Part B and Medicare Part D Income-Related Monthly Adjustment Amount (IRMAA)?Nov 14, 2024
- How is the income-related monthly adjustment amount or IRMAA affected if my income goes down?Nov 15, 2025
- What can I do if I do not agree with the Social Security Administration's income-related monthly adjustment amount or IRMAA assessment?Apr 20, 2024
- I have VA benefits and do not have Medicare drug coverage, so why am I being charged IRMAA when I am not even enrolled in a Part D plan?Nov 15, 2025
- Can I be disenrolled from my Medicare prescription drug plan if I refuse to pay my Medicare Part D IRMAA?Nov 15, 2025
- Can I be assessed an Income-Related Monthly Adjustment Amount (IRMAA) for Medicare Part D if I am enrolled in a Medicare Advantage (MAPD) plan?Nov 15, 2025
- How do I pay my Medicare Part D IRMAA or Income-Related Monthly Adjustment Amount?Jun 04, 2025
- Can I be assessed Part D IRMAA if I am not enrolled in a Medicare drug plan?Apr 20, 2024
- Can I be assessed an Income Related Monthly Adjustment Amount (IRMAA) if I am enrolled in my employer's Medicare drug plan?Nov 15, 2025
- I stopped working and now earn less than the IRMAA threshold, can I ask Social Security to reconsider my IRMAA premiums?Apr 23, 2025
Late-Enrollment Penalty (LEP) (6)
- What happens if I drop my Part D plan because of insufficient use and re-enroll in a few years?Jul 29, 2025
- Does prescription drug coverage under a Medigap (or Medicare Supplement) plan H, I or J qualify as creditable coverage for purposes of avoiding the Medicare Part D late enrollment penalty?May 29, 2025
- I did not enroll in a Medicare Part D plan when I was first eligible, how do I calculate my Medicare Part D late-enrollment premium penalty?Jul 29, 2025
- How do I calculate my Medicare Part D Late-Enrollment Penalty?Jul 29, 2025
- If I decide not to join any Medicare prescription drug plan, and I do not have any other prescription coverage, how long will I have to pay the late-enrollment premium penalty?Jul 29, 2025
- What is the Medicare Part D late enrollment penalty (LEP)?Jul 29, 2025
Living with your Part D plan (6)
- What is a Medicare Part D coverage determination?Dec 01, 2019
- How do I drop my Medicare Part D prescription drug plan?Jul 29, 2025
- What is the BIN, PCN, and RxGROUP number for my Medicare Part D prescription drug plan?Jan 21, 2026
- What should I do if I don't want to change my Medicare plan during the Medicare annual Open Enrollment Period?Nov 02, 2025
- Why did the monthly premium of my Medicare prescription drug plan almost double?Jun 24, 2024
- Can my Medicare Part D plan disenroll me if I don't pay my monthly premiums?Apr 08, 2025
Medicaid, LIS, & Extra Help (13)
- I am on Medicaid and Medicare assigned me a Part D plan that does not cover one of my medications. What do I do?Jan 27, 2025
- Can I still apply for the Medicare Part D Extra Help program even though I am already enrolled in a Medicare Part D plan?Feb 06, 2026
- How can I get financial "Extra Help" with my Medicare Part D prescription drug costs?Feb 06, 2026
- If I qualify for Extra Help, will my monthly Medicare drug plan premium be $0?Aug 09, 2026
- What is a Medicare Savings Program (MSP)?Feb 06, 2026
- What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money?Feb 06, 2026
- What is SLMB or a Specified Low Income Medicare Beneficiary?Feb 06, 2026
- If I am Dual Eligible and qualify for Extra Help, will my Medicare Part D drug plan premium always be $0?Aug 05, 2026
- How often do I need to apply for Medicare Part D Extra Help?May 06, 2026
- What is the Medicare Savings Program for Qualified Disabled Working Individuals (QDWI)?Feb 06, 2026
- What is Extra Help or the Low-Income Subsidy (LIS)?Feb 06, 2026
- Can I change my Medicare Part D plan at any time if I qualify for Extra Help or the Low-Income Subsidy?Feb 17, 2025
- What is the Qualifying Individual (QI) program and how can it save me money?Feb 06, 2026
Medicare Advantage plans (MAPD) (18)
- Can I use my Medicare Advantage plan as I travel throughout the United States?Dec 17, 2024
- What is a Medicare Advantage plan?Aug 02, 2022
- What is a Preferred Provider Organization (PPO) Medicare Advantage Plan?Sep 22, 2023
- What is a Medicare Advantage Private Fee-for-Service (PFFS) plan?Oct 28, 2024
- Can my Medicare Advantage plan drop me from my plan?Jun 02, 2025
- Is there a difference between a Medicare Part D prescription drug plan (PDP) and a Medicare Advantage plan (MA/MAPD)?Jul 06, 2025
- What is an HMO POS Medicare Advantage Plan?Mar 06, 2024
- What is a Health Maintenance Organization (HMO) Medicare Advantage Plan?Apr 11, 2024
- What are Medicare Coordinated Care Plans?Apr 20, 2024
- MA and MAPD: What is the difference between a Medicare Advantage MA plan and a Medicare Advantage MAPD plan?Jul 06, 2025
- If I travel between two states throughout the year (Maine and Florida), is there a Medicare Advantage plan that can provide coverage in both states without additional cost?Oct 22, 2024
- What happens when I reach my Medicare Advantage plan maximum out of pocket limit (MOOP)?Jul 01, 2025
- What is a Medicare Advantage Medicare-Medicaid plan (MMP)?Nov 02, 2024
- Does the type of Medicare Advantage plan affect my out-of-network coverage as I travel?Feb 26, 2025
- Do I still pay my Medicare Part B premium if I enrolled in a Medicare Advantage plan with a $0 premium?Dec 13, 2024
- Can I enroll in a Medicare Advantage plan and then add prescription drug coverage through a stand-alone Medicare Part D plan?Oct 28, 2024
- What is a Medicare Advantage plan and how does a Medicare Advantage plan compare to a stand-alone Medicare Part D plan (PDP)?Apr 06, 2025
- Do any Medicare Advantage plans refund or "Giveback" a portion of my Medicare Part B premium?Oct 13, 2024
Medicare Enrollment Periods (IEP & AEP) (5)
- I turn 65 in September so when do I enroll in Medicare Part D?May 25, 2023
- When is the annual Open Enrollment Period (AEP) for Medicare Part D plans?Feb 26, 2025
- I will turn 65 in February. When should I enroll in Medicare?Oct 22, 2024
- What is the Medicare annual Open Enrollment Period (AEP/OEP)?Sep 03, 2025
- What is the Medicare Part D IEP or Initial Enrollment Period?Jul 01, 2025
Medicare Medical Savings Account plans (MSA) (1)
Medicare Part B (2)
- What is Medicare Part B coverage?Aug 02, 2022
- What is the Medicare Part B late-enrollment penalty?Jun 02, 2025
Medicare Part D enrollment (1)
Medicare plan disenrollment (6)
- What should I do if I disenrolled from my Medicare Part D plan for next year, but it was a mistake, and I wish to stay enrolled in my plan?Jan 27, 2025
- When I enroll in a new Medicare Part D prescription drug plan, do I need to disenroll from my old Medicare Part D plan?Dec 04, 2024
- Can I re-enroll in my Medicare Part D plan if I re-pay my unpaid premiums?Jun 06, 2025
- Can I drop my Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA-OEP)?Jan 03, 2025
- Special Enrollment Period for Service Area Reduction (SAR SEP): When your Medicare Part D or Medicare Advantage plan is cancelled or not offered next year.Feb 03, 2026
- What is the Medicare Advantage Open Enrollment Period (MA OEP) - and why would I use the MA-OEP?Feb 03, 2025
Medicare Supplements or Medigap (11)
- Can I join a Medicare Supplement plan if I am under 65 and Medicare eligible?May 28, 2026
- How do I get Medicare prescription drug coverage to go with a Medigap policy?Nov 04, 2023
- How will my Medigap Policy work with my Medicare prescription drug coverage?Nov 06, 2019
- Are Medicare Advantage plans the same as Medicare Supplements or Medigap plans?Nov 16, 2025
- Do I have a trial right to leave my new Medicare Advantage plan within the first 12 months and return to my previous Medicare Supplement?May 19, 2025
- Can I join a Medicare Advantage plan if I already have a Medicare Supplement?Oct 22, 2024
- Can I join a Medicare Supplement if I already have a Medicare Advantage plan?Apr 12, 2023
- I learned that Medigap Plan F cannot be sold after 2020. If I am already enrolled in a Plan F, will I be able to keep my Plan F beyond 2020?Jul 10, 2023
- What are the Medicare Supplement plan benefits and how will they change in 2026?Nov 16, 2025
- When is the Medigap Open Enrollment Period?Apr 27, 2020
- Does my Medicare supplement insurance (Medigap) policy cover me when I travel outside the U.S.?May 30, 2023
Moving and Medicare Part D (1)
Online Tool Tips (3)
Other Q1Medicare tips and questions (1)
- What is a SHIP?Jul 07, 2023
Out-of-Pocket: TrOOP, RxMOOP, and MOOP (5)
- Does the Medicare Part D maximum out-of-pocket spending limit (RxMOOP) include spending on non-Part D drugs?Oct 04, 2025
- Is it possible that I will spend less than $2,000 out-of-pocket for my Part D formulary drugs and still meet the annual $2,000 prescription drug spending limit?Dec 09, 2024
- What exactly is TrOOP or True Out-of-Pocket costs?Mar 19, 2025
- What is my Medicare Advantage plan's maximum out-of-pocket limit (MOOP)?Oct 28, 2024
- What is the Medicare Part D RxMOOP?Apr 10, 2025
Paying your premiums (4)
- Why am I not allowed to have my Medicare Part D premiums automatically deducted from my monthly Social Security check?Dec 23, 2025
- When will Social Security begin deducting my Medicare plan premiums from my monthly Social Security check?Jun 06, 2025
- I joined a Medicare Advantage plan with a Part B premium "Giveback" or rebate, so when should I start receiving my Part B premium rebate?Dec 06, 2025
- I want to drop my Medicare plan and cannot find a Special Enrollment Period (SEP), what happens if I just stop paying my Medicare prescription drug plan premiums?Apr 09, 2025
Special Enrollment Periods (SEPs) (16)
- If I develop a chronic illness, can I use a Special Enrollment Period to join a Medicare Advantage Special Needs Plan?Mar 27, 2025
- Is there a Special Enrollment Period for Medicare beneficiaries affected by natural disasters such as a hurricane, wildfire, flood, or earthquake?Jun 01, 2025
- Is there a Special Enrollment to leave a Medicare Advantage plan within the first 12 months and return to my old Medicare Supplement?Jun 27, 2025
- Am I granted a Special Enrollment Period when CMS terminates my Medicare Advantage plan's contract?Jun 05, 2025
- What is a Medicare Part D Special Enrollment Period (SEP)?Feb 02, 2025
- We just moved from North Carolina to Florida and our Medicare plan was cancelled because of our relocation. Can we enroll back into our same Medicare plan now (July) or do we have to wait until November/December?May 31, 2023
- What is the 5-star Special Enrollment Period?Jan 27, 2025
- What are the Medicare Part D Special Enrollment Periods (SEP)?May 06, 2026
- Can I change Medicare plans using a Special Enrollment Period based on exceptional circumstances?Dec 17, 2024
- Can I change Medicare plans more than once during a Special Enrollment Period (SEP)?Apr 17, 2025
- When a Non-Renewing Medicare Part D or Medicare Advantage plan reassigns members to another plan does the SEP through February apply?Jul 10, 2023
- If I change Medicare Advantage plans during the year, will the amount that I have already spent out-of-pocket for Medicare Part A and Part B coverage transfer to the MOOP of my new plan?Mar 09, 2025
- If I change my Medicare prescription drug plan during the year, will my drug deductible transfer to the new Part D plan?Aug 02, 2025
- Can I get a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan's network?Apr 08, 2025
- Can I get a Special Enrollment Period and change Medicare plans if I was provided false or misleading information during the Medicare Part D enrollment process?May 23, 2025
- I turned 65 this year and joined a Medicare Advantage plan with drug coverage, can I now get a Special Enrollment Period to leave my Medicare plan since I have been enrolled for less than a year?May 25, 2025
Specific healthcare coverage (1)
Star Ratings & Medicare plan quality (6)
- I just selected a Medicare Part D plan and now the CMS Part D plan star ratings are online. Are the plan ratings really important?May 30, 2023
- What do the Medicare plan star ratings measure?Dec 02, 2024
- Is there any risk associated with using the 5-Star Special Enrollment Period?Jan 19, 2025
- What are the Medicare plan quality Star Ratings?Dec 02, 2024
- Is there a Special Enrollment Period granted to people enrolled in a sanctioned Medicare Part D or Medicare Advantage plan?Apr 20, 2024
- Is there a Special Enrollment Period (SEP) so we can leave a consistently low-rated Medicare Part D or Medicare Advantage Plan?Jun 06, 2025
Straddle Claims (3)
- What are Medicare Part D "Straddle Claims"?Mar 17, 2025
- If I have not yet met my initial deductible and must fill a $1500 prescription, will any of the $1500 be applied to the my coverage [initial coverage phase], or will I have to pay the whole $1500 before my coverage goes in to effect?Feb 03, 2025
- How does the Medicare Part D Initial Deductible work? I use a drug with a $47 copay, but had to pay $390.Jan 24, 2025
Supplemental Benefits (1)
Understanding your Formulary (3)
- Do any Medicare Part D plans cover extended or bonus drugs beyond the normal Medicare Part D formulary?May 25, 2025
- Will my Medicare Part D prescription drug plan notify me if the plan's formulary changes during the year?May 24, 2024
- What are Medicare Part D prescription drug Quantity Limits (QL)?Jul 02, 2024