Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Jun, 06 2023 — Medicare Part D Catastrophic Coverage is the fourth and final part of your Medicare Part D prescription drug plan coverage and is designed to help reduce the out-of-pocket spending for people with hi . . .

Jun, 06 2023 — 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 . . .

Jun, 06 2023 — Both.  When you purchase your medications, the retail cost of your drug can move you from one part of your Medicare Part D plan coverage into another part. When this occurs and your prescripti . . .

Jun, 06 2023 — It depends.  In general, you should find similar drug costs as you travel across the country.  But, since retail drug prices can vary between network pharmacies, your actual drug costs can . . .

Jun, 06 2023 — No.  You are not required to use your Medicare Part D plan even when you are buying a formulary drug at one of your Medicare plan's network pharmacies. However, except in certain situations (e . . .

Jun, 06 2023 — This 2006 policy establishes that Medicare beneficiaries can purchase drugs at lower pharmacy prices without using their Medicare drug plan (during a time when the beneficiary pays 100% of the cost) - and ask the plan to add the purchase to their total out-of-pocket costs.

Jun, 06 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 . . .

Jun, 06 2023 — Yes. Your retail drug costs (and coverage costs) can vary widely between Medicare Part D plans and between the different pharmacies used by your Medicare Part D plans - and retail prices can change on a weekly basis.

Jun, 06 2023 — Yes. You can apply for the Medicare Part D financial Extra Help program (or Low-Income Subsidy) at any time throughout the plan year - even when you are already enrolled in a Medicare Part D plan. . . .

Jun, 06 2023 — Yes.  You can use your Medicare Part D prescription drug plan at any one of your plan’s network pharmacies across the country, and most Medicare prescription drug plans include 50,000 to 65 . . .

Jun, 06 2023 — Not exactly.  You will enter the Donut Hole based on the retail value of your formulary drug purchases - not just your co-payment (although a portion (or maybe all) of your co-payment will make u . . .

Jun, 06 2023 — Yes, you are responsible for the copayment of the purchase plus cost-sharing on the amount of the purchase that exceeds your Medicare Part D plan's Initial Coverage Limit ($4,660 in 2023 and $5,030 in . . .

Jun, 06 2023 — You will pay $62.50 in the 2023 Donut Hole or Coverage Gap and $12.50 in the Catastrophic Coverage phase for any formulary drug with a $250 retail value. Once the total retail value of your Medic . . .

Jun, 06 2023 — You will receive a 75% discount on all formulary drug purchases.  The formulary drug tier (such as a Tier 5 Specialty Drug) does not affect your Donut Hole discount. So, if you purchase a Ti . . .

Jun, 06 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 . . .

Jun, 06 2023 — If you would like to check on the status of your Medicare Part D plan enrollment online, you can log into your https://myMedicare.gov account or call a Medicare representative at 1-800-Medicare (1-800 . . .

Jun, 02 2023 — No. Do not simply mail a premium payment check to your Medicare plan. Contact your plan's Member Services department and explain your situation, confirming your mailing address. Then make an alternative premium payment if necessary while awaiting your new Coupon Book's arrival.

May, 31 2023 — The Medicare annual Open Enrollment Period is the same every year - and begins on October 15th and continues for seven (7) weeks through December 7th. During the AEP, you can join, change, or drop . . .

May, 31 2023 — On January 1st, your Medicare Part D plan will start over - and you will no longer be in the Coverage Gap. If your Medicare Part D plan has an initial deductible, you will need to pay the initial d . . .

May, 31 2023 — Yes.  Medicare Part D prescription drug coverage is voluntary and you can use a Drug Discount Coupon or Drug Discount Card to purchase your medications instead of your Medicare Part D plan covera . . .

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 . . .

Jun, 06 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 . . .

May, 31 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 . . .

Apr, 28 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 . . .

May, 28 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 . . .

May, 26 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 . . .

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 . . .

Apr, 28 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 . . .

Mar, 28 2023 — 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.

May, 05 2023 — 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 . . .

May, 06 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 . . .