Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Aug, 16 2022 — The maximum out-of-pocket spending limit for Part D prescription drugs. In 2024, RxMOOP will be TrOOP (around $7,750) and then starting in 2025, RxMOOP will be $2,000 and will then change each year thereafter along with other Medicare Part D plan parameters.

Jul, 25 2022 — 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 . . .

Jul, 27 2022 — Yes. The retail prices for your Medicare Part D formulary drugs can change throughout the plan year (often increasing slightly) - and retail drug prices can vary pharmacy-to-pharmacy - mid-year incre . . .

Jul, 26 2022 — As we move through the warmer months of the year, we need to think more about the combination of sun, heat, and humidity and how we can protect ourselves and our skin during these longer, warmer days. The key is taking precautions - and seeking help when necessary.

Jul, 25 2022 — 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 hig . . .

Aug, 16 2022 — Yes, in some situations you have the right to ask your Medicare prescription drug plan to move a formulary medication to a lower-costing formulary tier. But, you cannot reduce the cost of a Tier 5 Specialty drug, nor can you reduce the cost of a now-covered, non-formulary drug.

Aug, 16 2022 — Only in very limited situations.   In 2016, the Centers for Medicare and Medicaid Services (CMS) updated their Prescription Drug Manual and added some guidance for the exceptional circumstanc . . .

Aug, 16 2022 — The Centers for Medicare and Medicaid Services (CMS) has recognized that some insulin delivery systems may now be covered by a Medicare Part D prescription drug plan when the devices are delivering in . . .

Jul, 11 2022 — Yes. In 2022, over 2,800 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium “Giveback” - or about 14,000 unique plan/county combinations of different Medicare Advantage plans - 2022 Part B give-backs can range up to $148.50 or mor

Jul, 27 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 . . .

Mar, 19 2022 — 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 . . .

Mar, 14 2022 — 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 . . .

Jul, 26 2022 — 95% of your brand-name drug's retail cost is counted toward exiting the Donut Hole. If your monthly purchases of formulary medications consistently have a retail value of over $370, you will e . . .

Mar, 14 2022 — Yes. Medicare provides a Special Enrollment Period (SEP) for people who left their Medicare Supplement (Medigap plan) and joined a Medicare Advantage plan for the first time and now within the 12-month trial period wish to return to their Medicare Supplement.

Aug, 02 2022 — The Medicare Part D late enrollment premium penalty (LEP) is an additional cost you will pay every month because you did not enroll into a Medicare Part D prescription drug plan when you were initiall . . .

Mar, 13 2022 — 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 . . .

May, 20 2022 — Yes.  You can estimate if - or when - you will enter Catastrophic Coverage based on your average monthly retail drug cost (only the retail price for your formulary drugs). For example, if you . . .

Mar, 14 2022 — Yes, you will be granted a Special Enrollment Period (SEP) from the start of the government-declared disaster and continuing 2 full months following the declared end date - or the announced disaster end date - whichever is later.

Nov, 26 2021 — The last Medicare plan enrollment application received before the end of the annual Open Enrollment Period or AEP (the AEP ends on December 7th) determines your Medicare Part D plan or Medicare A . . .

Nov, 26 2021 — No.  When you change or switch to a new Medicare Part D prescription drug plan, you do not need to contact or cancel your old Medicare plan. Your old or existing Medicare Part D plan will be . . .

Aug, 17 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 . . .

Aug, 12 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 . . .

Jan, 13 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 . . .

Jul, 04 2022 — 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 ( . . .

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.

Jul, 26 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 . . .

Aug, 17 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, 12 2021 — 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, . . .

Mar, 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, 27 2022 — 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 . . .

Jan, 13 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 continuous Special Enrollment Period and ca . . .

Jul, 11 2022 — Yes. In 2022, over 2,800 counties (or ZIP code areas) include at least one Medicare Advantage plan with a Part B premium “Giveback” - or about 14,000 unique plan/county combinations of different Medicare Advantage plans - 2022 Part B give-backs can range up to $148.50 or mor

Jul, 27 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 . . .

Aug, 11 2021 — 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 . . .

Aug, 02 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).

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 . . .

Jul, 26 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 . . .

Mar, 14 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 . . .