Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Mar, 21 2023 — If you have Medicare and full Medicaid coverage, you are eligible for the Medicare Part D Extra Help or the Low-Income Subsidy (LIS) program and you are granted a Special Enrollment Period (SEP) that . . .

Mar, 20 2023 — Yes, in some situations you have the right to ask your Medicare prescription drug plan to move a formulary medication to a lower-costing formulary tier. But, you cannot reduce the cost of a Tier 5 Specialty drug, nor can you reduce the cost of a now-covered, non-formulary drug.

Mar, 20 2023 — A PDP is a stand-alone Medicare Part D prescription drug plan (only offering drug coverage) and a MADP is a Medicare Advantage plan that includes prescription drug coverage along with Medicare Part A and Part B coverage - and maybe even additional or supplemental benefits.

Mar, 20 2023 — A Medicare Part D PDP is a Medicare prescription drug plan that provides insurance coverage for a specific list of out-patient prescription drugs at participating pharmacies. Your prescription drug costs should be lower with a PDP.

Mar, 20 2023 — 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 . . .

Mar, 20 2023 — Yes. Although, Medicare Part D drug plans must continue to cover a medication dropped from the plan’s formulary until the end of the plan year for anyone using the particular medication, Medicare allows several exceptions when a drug plan can drop a formulary drug mid-year.

Mar, 20 2023 — Yes.  You can use our Q1Rx® Medicare Part D Drug Finder (Q1Rx.com) to see how all Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include drug coverage (MAPD . . .

Mar, 18 2023 — As noted by the Social Security Administration, the Qualified Disabled Working Individuals (QDWI) program is a Medicare Savings Program that is for people who are under the age of 65, disabled, and no . . .

Mar, 18 2023 — The Qualifying Individual (QI) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare.  QI helps low-income Medicare beneficiaries pay their Medicare P . . .

Mar, 18 2023 — A Medicare Savings Program (MSP) is one of four different Medicaid programs (QMB, SLMB, QI, QDWI) available for people with limited financial resources and, depending on a person's income and assets, . . .

Mar, 18 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, 18 2023 — The prior notification of a mid-year formulary change will depend on the type of formulary change. Your Medicare drug plan does not need to provide you prior notification if a newly-introduced generic drug replaces a brand-name formulary drug or the FDA recalls a formulary drug.

Mar, 18 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 . . .

Mar, 18 2023 — Drug Tiers are an attempt to "logically" group drugs (such as generics, preferred-generics, brand drugs, and specialty drugs) within a list (drug formulary). All of your Medicare Part D prescriptio . . .

Mar, 16 2023 — 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 . . .

Mar, 16 2023 — Yes.  In 2023, the Inflation Reduction Act (IRA) of 2022 introduces a provision similar to the 2021-2022 Senior Savings Model with insulin provided at a $35 30-day co-pay throughout all phases . . .

Mar, 16 2023 — The Centers for Medicare and Medicaid Services (CMS) periodically releases the enrollment figures for Medicare Part D and Medicare Advantage plans and we included this information in our Medicare Part . . .

Mar, 16 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 . . .

Mar, 16 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).

Mar, 16 2023 — Your Medicare Advantage plan’s Maximum Out-of-Pocket Limit (MOOP) is the total amount you will spend this year on in-network co-payments and co-insurance for covered or eligible Medicare Part A and Medicare Part B medical services - but, some healthcare coverage may be excluded

Feb, 12 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 . . .

Feb, 12 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 . . .

Feb, 12 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 Reductio . . .

Feb, 12 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 . . .

Feb, 12 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.

Feb, 16 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 . . .

Mar, 18 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 . . .

Feb, 12 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 . . .

Feb, 19 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 . . .

Nov, 13 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 . . .

Mar, 16 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 . . .

Jan, 15 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 . . .

Nov, 10 2022 — 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.

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 . . .

Feb, 12 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 . . .

Mar, 16 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).

Feb, 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 . . .

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 . . .

Mar, 16 2023 — 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 . . .