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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.
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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.
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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 . . .
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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.
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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 . . .
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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 . . .
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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 . . .
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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 . . .
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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.
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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 . . .
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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 - . . .
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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 . . .
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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 . . .
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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.
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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 . . .
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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 . . .
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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 . . .
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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 . . .
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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 . . .
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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 . . .