Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Jan, 29 2023 — You will only pay the Tier 1 or Tier 2 copayment for your medications, if these two formulary tiers are excluded from the initial deductible - even when the plan's initial deductible is not yet met. . . .

Jan, 27 2023 — All Insulin products covered by your Medicare Part D drug plan will cost $35 or less for a 30-day supply.In 2023, the Inflation Reduction Act (IRA) introduces an insulin cost-saving provision - simil . . .

Jan, 27 2023 — There are several reasons why you are still paying a monthly Medicare Part D plan premium even though you are qualified for Medicaid or Extra Help benefits: (1) Your plan does not meet the bench . . .

Jan, 27 2023 — Medicare Part D prescription drug plans can change their plan formulary or drug list throughout the plan year - and you may find that new Part D drugs are added - or dropped - or formulary drugs may h . . .

Jan, 27 2023 — 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

Jan, 27 2023 — The initial Coverage Phase is the second part of your Medicare drug plan and follows the Initial Deductible (if your plan has a deductible). During this phase, you and your Medicare Part D plan share in the cost of your formulary drugs (for example, you pay $47 for a $500 drug).

Jan, 27 2023 — Not always.  It is always worth checking Drug Discount Card prices, but be sure to compare these discount prices to your Medicare plan's coverage cost or negotiated retail drug price and you may . . .

Jan, 23 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 . . .

Jan, 23 2023 — Yes.  The Medicare Advantage Open Enrollment Period (MA-OEP) runs from January 1st through March 31st.  During the MA-OEP, you are allowed to drop your Medicare Advantage plan (MAPD or MA), . . .

Jan, 23 2023 — Yes.  According to the Centers for Medicare and Medicaid Services (CMS), the transition fill policy will apply to both non-formulary Part D drugs and “Part D drugs that are on a sponso . . .

Jan, 23 2023 — Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ acces . . .

Jan, 22 2023 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Jan, 22 2023 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Jan, 22 2023 — Yes.  You may be able to use a drug discount card to buy prescriptions even if you are enrolled in a Medicare Advantage plan. However, you will need to read the discount card's "fine print" as . . .

Jan, 22 2023 — No, whether you qualify for full- or partial*-Extra Help - you can only change Medicare plans three times a year.  If you are eligible for the Medicare Part D Extra Help or the Low-Income Subsidy . . .

Jan, 22 2023 — A transition fill is a temporary 30-day prescription supply or refill of a non-formulary drug provided to: People who have stayed with the same Medicare drug plan into the next year and now fi . . .

Jan, 22 2023 — A formulary exception is a type of coverage determination request whereby a Medicare plan member asks the plan to cover a non-formulary drug or amend the plan's usage management restrictions that are . . .

Jan, 22 2023 — Usually 90 days. Your 30-day supply transition fill is usually only valid for the first 90 days of your Medicare drug plan enrollment. If you are living in a long-term care (LTC) facility, then . . .

Jan, 22 2023 — The Medicare Part D Extra Help or Low-Income Subsidy (LIS) program helps people with limited financial resources pay for their Medicare Part D prescription drug coverage. If you receive Medicare Pa . . .

Jan, 22 2023 — No - unless the non-Part D drug is used for a medically-accepted indication. Specific prescription medications are excluded from the Medicare Part D program or sometimes medications are removed fro . . .

Dec, 24 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 . . .

Oct, 30 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 . . .

Dec, 12 2022 — 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 the Inflation Reductio . . .

Oct, 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.

Dec, 11 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 . . .

Nov, 05 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 . . .

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 . . .

Oct, 13 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, 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 . . .

Nov, 05 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 . . .

Oct, 27 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).

Nov, 09 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 . . .