Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Oct, 04 2024 — 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)  You may pay a monthly premium . . .

Oct, 04 2024 — 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 . . .

Oct, 04 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).

Oct, 03 2024 — When you are "crosswalked", you are automatically moved from your current Medicare plan to another Medicare Part D plan or Medicare Advantage. This can mean that your plan is being merging or consolidated into another Medicare plan - with new coverage features.

Oct, 01 2024 — No. The annual $2,000 Medicare Part D maximum out-of-pocket spending limit (TrOOP or RxMOOP) does not include non-Part D drugs or drugs excluded from the Part D program - even when the drugs are on the Medicare drug plan's formulary as Bonus or Supplemental drugs.

Sep, 28 2024 — 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.

Sep, 09 2024 — Yes. You are permitted to disenroll from your Medicare Part D plan or Medicare Advantage plan during the Annual Open Enrollment Period (AEP) -- October 15th through December 7th -- or outside the AEP . . .

Sep, 09 2024 — 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, unless you have opted out of rec . . .

Sep, 09 2024 — Your Medicare plan can disenroll you from the Medicare plan, send your unpaid balance to a debt collection agency, require you to pay unpaid premiums if you ever wish to rejoin the plan, and you may also incur a late-enrollment penalty if you rejoin any Medicare drug plan

Sep, 09 2024 — Yes.  The Inflation Reduction Act (IRA) requires that a 30-day supply of any insulin product on a 2025 Medicare Part D prescriptions drug plan's formulary is covered at a maximum $35 copay throu . . .

Sep, 09 2024 — Yes, you are responsible for the copayment of the formulary drug purchase in the Initial Coverage phase - plus - the cost-sharing on the amount of the purchase price that exceeds your Medicare Part D . . .

Sep, 04 2024 — If you are enrolled in a Medicare Part D prescription drug plan or a Medicare Advantage plan sanctioned by the Centers for Medicare and Medicaid Services (CMS), your Medicare plan coverage is not us . . .

Aug, 20 2024 — You do not pay anything more for your Medicare Part A and Medicare Part B covered services for the remainder of the year. Your Medicare Advantage plan’s MOOP or Maximum Out-of-Pocket limit . . .

Aug, 14 2024 — Maybe, depending on whether you are using a traditional insulin pump or a disposable insulin pump.  The Centers for Medicare and Medicaid Services (CMS) has recognized that some disposable insuli . . .

Aug, 14 2024 — Yes.  Under certain conditions, Medicare will cover a continuous glucose monitor (CGM) - and Medicare specifically notes: “If your doctor [primary care physician] determines that you meet . . .

Aug, 12 2024 — RxMOOP is the maximum out-of-pocket spending limit for Medicare Part D prescription drugs. In 2024, RxMOOP will be the TrOOP threshold ($8,000). Starting in 2025, RxMOOP will be $2,000 and can change each year thereafter along with other Medicare Part D plan parameters.

Aug, 11 2024 — On August 8, 2024, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare plan Enrollment Disenrollment guidance combining two Medicare Manual chapters: the . . .

Aug, 07 2024 — In 2024, the Inflation Reduction Act, eliminated cost-sharing for all formulary drugs purchased in the Catastrophic Coverage phase. For information about the current plan year, please see: Q1Faq.com . . .

Aug, 07 2024 — The Medicare Part D prescription drug program provides prescription drug coverage through either stand-alone Medicare prescription drug plan (PDPs) or Medicare Advantage plans that include prescriptio . . .

Aug, 07 2024 — No.  No matter what Medicare Part D drug plan you choose, you will have no cost-sharing for formulary Medicare Part D drugs once meeting your annual total out-of-pocket spending limit and enter C . . .

Jan, 10 2024 — 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 . . .

May, 24 2024 — 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 Re . . .

Oct, 04 2024 — 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)  You may pay a monthly premium . . .

Jul, 19 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 . . .

Aug, 04 2024 — 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.

May, 16 2024 — 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, 06 2024 — 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 . . .

Jul, 06 2024 — 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 . . .

Aug, 07 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 . . .

Jul, 06 2024 — 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 . . .

Jun, 04 2024 — Yes. In 2024, over 3,000 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium “Giveback” - 2024 Part B give-backs can range up to $164.90.

Dec, 14 2023 — 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 . . .

Aug, 07 2024 — TrOOP or your total out-of-pocket spending is the total amount you (or others on your behalf) have spent during the year on your formulary drugs.  The TrOOP threshold is the maximum spending befo . . .

Jul, 19 2024 — No Medicare and Humana are not the same. Humana, Inc. is one of the largest insurance companies that provides, along with other products, Medicare Advantage plans and Medicare Part D prescription . . .

Oct, 04 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).

Apr, 20 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 . . .

Aug, 07 2024 — Your Initial Coverage Limit (ICL) is the "boundary" between your Medicare Part D plan's Initial Coverage phase (where you and your drug plan share the cost of your drug purchases) and the Coverage Gap (where you receive a fixed 75% Donut Hole discount on formulary drugs

May, 15 2024 — 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).Qualifyin . . .