Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

May, 05 2025 — Maybe, depending on your situation.  Most people cannot change their stand-alone Medicare Part D plan coverage after the December 7th annual Open Enrollment Period (AEP) deadline.  And Medi . . .

May, 05 2025 — Your Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan (MA, MAPD, or SNP) coverage can be cancelled because of changes to the Medicare plan or because of something that you have . . .

May, 05 2025 — It depends on your financial status.  If you have been approved for financial "Extra Help" with your Medicare Part D expenses (and have had no changes in your finances), you will not need to re-a . . .

May, 03 2025 — 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.

Apr, 23 2025 — Yes.  If your income has decreased and moved you to a lower Medicare Part D income-related monthly adjustment amount (IRMAA) bracket, you should consider filing an appeal to have your IRMAA pre . . .

Apr, 17 2025 — A Special Needs Plan (SNP) is a type of Medicare Advantage plan (MAPD) with healthcare benefits, provider choices, and drug formularies (list of covered drugs) designed for people who meet certain . . .

Apr, 17 2025 — After meeting your Medicare Part D prescription drug plan's out-of-pocket spending limit (TrOOP), you will exit your Medicare plan's Initial Coverage phase and enter the last phase of Medicare Part D . . .

Apr, 17 2025 — Probably not.  But, you may be able to change your plans if you can find another Special Enrollment Period. A Special Enrollment Period (SEP) allows a person to change their Medicare Part D or . . .

Apr, 17 2025 — 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 . . .

Apr, 17 2025 — Your most recent Federal income tax returns are used to determine whether you pay an income-related monthly adjustment amount or IRMAA - however, this means that your current IRMAA is determined by yo . . .

Apr, 14 2025 — Yes. A Medicare beneficiary can use a Special Enrollment Period to join a Medicare Part D plan or Medicare Advantage plan if they lose or leave their employer's health plan (EGHP). A Medicare beneficiary also will be granted an SEP to leave their Medicare plan and join an EGHP.

Apr, 11 2025 — The Centers for Medicare and Medicaid Services (CMS) have implemented safe-guards to protect Medicare beneficiaries who inadvertently missed a Medicare Part D premium payment and require Medicare p . . .

Apr, 11 2025 — No, TrOOP does not count toward your Medicare Advantage plan's MOOP limit.  TrOOP and MOOP are two different measures of out-of-pocket (OOP) costs - and TrOOP and MOOP are not related, aside from . . .

Apr, 10 2025 — RxMOOP is the maximum out-of-pocket spending limit for Medicare Part D prescription drugs. In 2025, RxMOOP is $2,000 and can change each year thereafter along with other Medicare Part D plan parameters.

Apr, 09 2025 — The retail prices of your formulary drugs determine how fast you move through your Part D coverage and what you may pay for covered drugs as you move through the initial deductible and initial coverag . . .

Apr, 09 2025 — No for most Extra Help recipients.  In most cases, there are no Medicare Part D plans that are totally "free" to low-income Medicare beneficiaries, but there are plans with a $0 (or low) monthly . . .

Apr, 08 2025 — Yes.  As noted by the Centers for Medicare and Medicaid Services (CMS), a Medicare Part D or Medicare Advantage plan can disenroll a plan member for non-payment of premiums after proper notice an . . .

Apr, 08 2025 — If a person stops paying their Medicare Part D or Medicare Advantage plan's monthly premium, the Centers for Medicare and Medicaid Services (CMS) allows the Medicare plan to disenroll the member from . . .

Apr, 08 2025 — Not exactly.  After disenrollment, paying your past unpaid premiums will not get you automatically reinstated back into your Medicare drug plan. Rather, your plan will make a determination as to . . .

Apr, 08 2025 — 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 . . .

Jan, 26 2025 — 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 . . .

Jan, 05 2025 — Medicare Part D prescription drug plans provide insurance coverage for the out-patient prescription drugs covered by your drug plan - and works just like any other type of insurance: (1)  You . . .

Oct, 28 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 . . .

Feb, 11 2025 — 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.

Jan, 19 2025 — 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, 12 2025 — 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 . . .

Feb, 26 2025 — 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 . . .

Nov, 14 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 . . .

Feb, 07 2025 — 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 . . .

Mar, 19 2025 — TrOOP or your true out-of-pocket spending is the amount you - or others on your behalf - spend toward your Medicare Part D plan's formulary Part D drugs. For example, if you purchase a $100 formulary . . .

Apr, 17 2025 — 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, 13 2024 — Yes. In 2025, over 3,000 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium rebate or giveback - 2025 Part B rebates can range from $0.10 up to $174.70.

Jan, 27 2025 — You have two options: You can select a new Medicare Part D plan that covers all of your medications. Medicaid and "Extra Help" recipients may be able to use the Dual-Eligible Special Enrollment P . . .

Oct, 27 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).

Nov, 14 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

Mar, 12 2025 — 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). Quali . . .