Frequently Asked Questions about Q&A of the Day

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 . . .

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 ( . . .

Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs) . . .

00173056504Yes.  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, . . .

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 . . .

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

You can call the Social Security Administration to report the death of a Medicare beneficiary at 1-800-772-1213 (TTY 1-800-325-0778). As noted on the Social Security Administration site: "You . . .

Within 2 to 3 months.  Depending on any administrative issues, you can usually expect your Social Security check premium deductions to begin within 2 to 3 months after the start of a new Medicare . . .

In general, you must show that your failure to make timely premium payments was due to unique, unusual, or unexpected circumstances over which you had no control and could not reasonably have been e . . .

Sometimes your Medicare plan will not have enough time to organize the automatic premium deduction from your Social Security check, resulting in a 3+ month delay in premium payments - and instead the plan will ask that you pay the premium directly until auto deductions can begin.

You will never pay more than your Medicare Part D plan's negotiated retail drug price - so even when your low-costing generic drug is placed on an expensive formulary tier - you will pay the lower retail cost and not the higher co-pay.

No.  You do not need to cancel or disenroll from your existing Medicare Part D plan before enrolling in a new Medicare Part D prescription drug plan. When you change Medicare Part D prescripti . . .

Yes, in most cases.  When you move out of your Medicare Part D (PDP) or Medicare Advantage (MA or MAPD) plan's service area, you are granted a Special Enrollment Period to join another Medicare . . .

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.

Forever, except for a few situations.  The late-enrollment premium penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D presc . . .

You can get a 30-day temporary or transition prescription drug fill if you: stayed with the same Medicare Part D prescription drug plan (or Medicare Advantage plan that includes drug coverage) . . .

Yes, "when [these medications are] used to treat epilepsy, cancer, or a chronic mental health disorder". A certain group of prescription medications are specifically excluded from Medicare Part D p . . .

Not always.  If you are "Dual Eligible", qualifying for both Medicare and Medicaid, you will automatically qualify for the Medicare Part D full Low-Income Subsidy (LIS) or Extra Help program. . . .

Yes.   If you are a Medicare beneficiary and your annual income (MAGI) exceeds certain limits - and you are enrolled in a Medicare Advantage plan (HMO, PPO, or PFFS) that includes prescripti . . .

No.  Your Medicare Part D plan's Initial Deductible does not affect when you go into the Donut Hole or Coverage Gap.  However, your Initial Deductible will impact how quickly you exit the . . .

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 . . .

Yes. Even though Medicare plans sanctioned by the Centers for Medicare and Medicaid Services (CMS) are not allowed to accept new enrollment, Q1Medicare® shows “sanctioned” Medicare pl . . .

There are several reasons why you are paying more this year for your drugs even when you are in the same Medicare plan: Your drugs are no longer covered or covered at a higher price, you used a non-network or standard pharmacy, you lost Extra Help benefits, and more . . .

Forever, except for a few situations.  The late-enrollment premium penalty is permanent for most people over 65 and you will pay the penalty as long as you are enrolled in a Medicare Part D presc . . .

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 . . .

No.  If you wish to stay in your current Medicare Part D or Medicare Advantage plan, you do not need to do anything during the annual Open Enrollment Period (AEP) and you will be automatically re . . .

Q1Medicare offers a series of online tools to help you review and analyze Medicare Part D plans and Medicare Advantage plans (including plan finders, drug finders, and cost calculators). This FAQ includes an overview of our Q1Medicare online tools - along with a few tool tips.

Yes.  We have our Formulary Browser online that includes every Medicare Part D prescription drug plan (PDP) and Medicare Advantage plan (MAPD) formulary or drug list - and all plan formularies ar . . .

Yes.   If you are a Medicare beneficiary and your annual income (MAGI) exceeds certain limits - and you are enrolled in a Medicare Advantage plan (HMO, PPO, or PFFS) that includes prescripti . . .

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 . . .

The list of abbreviations used by the Centers for Medicare and Medicaid Services (CMS) describing the Medicare Part D or Medicare Advantage program can be rather long (about 140 pages or so), so here . . .

As noted on the Medicare website, the Centers for Medicare and Medicaid Services (CMS) current guidance on coverage related to the novel corona virus COVID-19 is as follows: Medicare covers FD . . .

Below are links to health departments in all states and Washington, DC, the 8 US territories, and the freely associated states. 50 U.S. State Health Department Websites Alabama Depa . . .

There are several ways to contact your Medicare Part D or Medicare Advantage plan: (1) Call the toll-free telephone number found on your Member ID card. (2) Call the toll-free telephone number we provide in our Medicare Plan Finders. (3) Call a Medicare representative.

Yes.  If your  annual income (MAGI) exceeds certain limits - and you are enrolled in an employer-sponsored Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan with prescr . . .

Within 2 to 3 months.  Depending on any administrative issues, you can usually expect your Social Security check premium deductions to begin within 2 to 3 months after the start of a new Medicare . . .

No.  TrOOP and MOOP are two different measures of out-of-pocket (OOP) costs - and TrOOP and MOOP are not related, aside from both defining OOP costs - and your TrOOP does not count toward your MO . . .

Yes, even though Medicare Advantage plans (MA or MAPD) usually have a service area for a specific county or ZIP code - and may not be as "portable" as a Medicare Supplement - you can travel with your . . .

No. A Medicare Part D plan will not allow you to request a tiering exception for a drug (moving a drug to a lower-costing formulary tier) when your plan has just approved your formulary exception request to cover the non-formulary drug.

Medicare Part D plans provide insurance coverage for prescription drugs - and just like any other type of insurance - you pay a monthly premium to a private company (like Aetna or Humana or UnitedHeal . . .