Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Sep, 28 2022 — 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).  However, coverage (a . . .

Sep, 27 2022 — If a person stops paying their Medicare Part D or Medicare Advantage plan's monthly premium, the Centers for Medicare and Medicaid Services (CMS) Medicare manual allows a Medicare plan to disenroll th . . .

Sep, 26 2022 — No.  When you turn 65, you can use your second initial enrollment period (IEP2) to join a Medicare Part D plan and you will not be assessed any late-enrollment penalty that you may have accrued . . .

Sep, 22 2022 — No. The Medicare annual wellness visit is not mandatory - but, the visit is provided at no cost every 12 months for people who have Medicare Part B coverage (and who see a provider who accepts Medicar . . .

Sep, 18 2022 — The maximum out-of-pocket spending limit for Part D prescription drugs. In 2024, RxMOOP will be TrOOP (around $7,750) and then starting in 2025, RxMOOP will be $2,000 and will then change each year thereafter along with other Medicare Part D plan parameters.

Sep, 18 2022 — Cost-Sharing refers to the portion of your Medicare Part D or Medicare Advantage plan coverage that you pay yourself - such as $47 for a Tier 3 brand-name drug that usually costs $250 retail or $20 to visit your primary care physician (PCP) or $75 to see a healthcare specialist.

Sep, 16 2022 — Co-Insurance is a type of cost-sharing used by Medicare Part D prescription drug plans or Medicare Advantage plans referring to a Medicare plan member paying a percentage of the medication's negotiate . . .

Sep, 16 2022 — Co-Payment or Co-Pay is a type of cost-sharing that refers to a fixed dollar amount you pay for a medication assigned to a logical grouping or Tier of medications. As reference, the Centers for M . . .

Sep, 16 2022 — Yes. You can use the Q1Medicare PDP-Finder Medicare Part D prescription drug Plan Finder to all Medicare Part D plans and coverage information in your state and you can use the MA-Finder to see all Medicare Advantage plans in your county or Zip Code area.

Sep, 14 2022 — 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. 2023 Medicare & . . .

Sep, 12 2022 — No, but . . .  you may pay a higher premium each month due to your late enrollment penalty.  The Medicare Part D program is voluntary and you are not required to join a drug plan during your . . .

Sep, 12 2022 — It depends on where you live.  If you are an under-65 Medicare beneficiary due to a disability or ESRD, your rights to join a Medicare Supplement will depend on your state's Medigap law. The c . . .

Sep, 12 2022 — A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that does not include prescription drug coverage (MA) - but you are permitted to join a stand-alone Medicare Part D d . . .

Sep, 12 2022 — A Private Fee-for-Service (or PFFS) plan is a type of Medicare Advantage plan with no established network of healthcare providers allowing you to visit any Medicare-approved doctor or hospital that accepts both Medicare and the Medicare Advantage plan’s terms and conditions.

Sep, 12 2022 — 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).

Sep, 08 2022 — Donut Hole Coverage or Gap Coverage, according to the Centers for Medicare and Medicaid (CMS) is defined as: After you have spent a certain amount of money for covered drugs, you have to pay all . . .

Sep, 08 2022 — Yes, your doctor can request an exception (or any other type of coverage determination) on your behalf.  In cases where delays may seriously affect your health, your doctor can also ask for an ex . . .

Sep, 08 2022 — If you have a prescription for a drug that isn't on your plan's formulary, you should ask your doctor if there is another drug you can take that is on your plan's formulary.  If your doctor can't . . .

Sep, 08 2022 — Both.  When you purchase your medications, the retail cost of your drug can move you from one part of your Medicare Part D plan coverage into another part. When this occurs and your prescripti . . .

Sep, 08 2022 — When you enroll in a Medicare Part D prescription drug plan, you will pay a certain price for your Part D drugs that are covered by your plan's formulary.  In the Initial Deductible (if your plan . . .

Aug, 17 2022 — 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 . . .

Aug, 12 2022 — 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, 27 2022 — You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap. As background, starting back in the 2011 Medicare Part D plan year, a discount or co-insurance ( . . .

Aug, 30 2022 — 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 2022 — 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.

Aug, 30 2022 — 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 . . .

Aug, 17 2022 — 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 . . .

Mar, 02 2022 — 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 . . .

Sep, 28 2022 — 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).  However, coverage (a . . .

Aug, 27 2022 — 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 . . .

Jan, 27 2022 — 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 . . .

Jan, 13 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 continuous Special Enrollment Period and ca . . .

Jul, 11 2022 — Yes. In 2022, over 2,800 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium “Giveback” - or about 14,000 unique plan/county combinations of different Medicare Advantage plans - 2022 Part B give-backs can range up to $148.50 or mor

Jul, 27 2022 — 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 . . .

Aug, 22 2022 — 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 . . .

Sep, 12 2022 — 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, 26 2022 — 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, 04 2022 — 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 . . .

Aug, 27 2022 — 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 Or . . .

Aug, 16 2022 — 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 . . .