Frequently Asked Questions about Q&A of the Day

Jul, 26 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 . . .

Jul, 10 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 . . .

Jul, 09 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 . . .

Aug, 12 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

Dec, 19 2022 — 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 . . .

Jul, 09 2023 — 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 ca . . .

Aug, 02 2023 — Your Medicare Part D late-enrollment penalty is calculated by multiplying the number of months you were without some form of "creditable" prescription drug coverage by 1% of the annual base Medicare Part D premium ($34.70 in 2024).

Apr, 01 2023 — In general, if you were involuntarily disenrolled from your Medicare Part D plan for not paying your monthly premiums, you must show that your failure to make timely premium payments was due to uniqu . . .

Jul, 24 2023 — 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.

Jul, 12 2023 — 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.

Feb, 12 2023 — 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.

Jul, 07 2023 — 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 . . .

Jul, 10 2023 — 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 . . .

May, 25 2023 — The Centers for Medicare and Medicaid Services (CMS) provides the following guidance explaining how Medicare beneficiaries can receive a refund or repayment of their overpaid copayments and premiums f . . .

Jul, 19 2023 — The Donut Hole or Coverage Gap is the third part of your Medicare Part D prescription drug coverage where you will pay 25% of the retail price for any prescriptions found on your plan's formulary or d . . .

Jul, 26 2023 — 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) . . .

Apr, 09 2023 — Maybe. If you are able to change or transfer to another Medicare Advantage plan offered by the same company during the plan year, you may be able to transfer the amount that you have spent for your Medicare Part A and Part B coverage toward your new plan's MOOP limit.

Aug, 02 2023 — 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 . . .

Jul, 09 2023 — 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 prescription dru . . .

Sep, 06 2022 — 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 . . .

Aug, 18 2023 — The complete list of Medicare abbreviations used by the Centers for Medicare and Medicaid Services (CMS) describing Medicare Part D prescription drug plans or Medicare Advantage plans is rather long ( . . .

Aug, 16 2023 — Your monthly Medicare Part D IRMAA (Income-Related Monthly Adjustment Amount) charges will be deducted automatically from your Social Security check, or . . . . . . If the amount of your Social Sec . . .

Aug, 14 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.

Aug, 12 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

Aug, 07 2023 — Yes.  If your Medicare Part D prescription drug plan cost-sharing is based on a percentage of retail price (such as 25% coinsurance), you will find your coverage cost can increase (or decrease) d . . .

Aug, 03 2023 — 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. . . .

Aug, 02 2023 — 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 . . .

Aug, 02 2023 — No.  When you turn 65, you can use your second initial enrollment period (IEP2) to join a Medicare Part D plan and you will not be assessed any late-enrollment penalty that you may have accrued . . .

Aug, 02 2023 — Your Medicare Part D late-enrollment penalty is calculated by multiplying the number of months you were without some form of "creditable" prescription drug coverage by 1% of the annual base Medicare Part D premium ($34.70 in 2024).

Jul, 28 2023 — Medicare Part D plans can change formulary or drug list designs each year and your Medicare prescription drug plan may have implemented utilization management (or drug usage management) restrictions i . . .

Jul, 26 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 . . .

Jul, 26 2023 — 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) . . .

Jul, 24 2023 — 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.

Jul, 19 2023 — The Donut Hole or Coverage Gap is the third part of your Medicare Part D prescription drug coverage where you will pay 25% of the retail price for any prescriptions found on your plan's formulary or d . . .

Jul, 19 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 . . .

Jul, 14 2023 — 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 . . .

Jul, 13 2023 — Maybe. This particular Special Enrollment Period (SEP) is exceptional, and will only be granted if the changes to your provider network are considered as "significant". In addition, you cannot simply . . .

Jul, 12 2023 — The Centers for Medicare and Medicaid Service (CMS) defines a Medicare Part D covered drug as: "A Part D covered drug is available only by prescription, approved by the FDA (or is a drug described un . . .

Jul, 12 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).

Jul, 12 2023 — 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.