Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

Nov, 26 2022 — Yes.  Medicare Part D prescription drug plans (PDPs and MAPDs) are required to keep track of each person’s prescription drug spending or TrOOP costs - so your out-of-pocket spending and . . .

Nov, 25 2022 — If you are enrolled in a Medicare Advantage plan (MA or MAPD) or Medicare Part D plan (PDP) that is no longer offered next year (and you are not automatically "crosswalked" or transferred to another M . . .

Nov, 25 2022 — The Medicare website provides you with guidance on paying your Medicare Part B (out-patient and doctor visit coverage) and notes that if you get: Social Security, Railroad Retirement Boa . . .

Nov, 25 2022 — If you use a Special Enrollment Period to change Medicare Part D drug plans during the year, your drug purchase history moves with you to your new Medicare plan. So if you are in the Donut Hole and move to another Part D plan, most likely you will still be in the Donut Hole.

Nov, 25 2022 — If you have disenrolled from your Medicare Part D plan (or Medicare Advantage plan) for next year and are still within the annual Open Enrollment Period (AEP - running each year from October 15th thro . . .

Nov, 25 2022 — Yes, if you are considering the 75% Donut Hole discount that you receive for all formulary drugs if you enter the Coverage Gap or Donut Hole.  In addition, a few Medicare drug plans may also off . . .

Nov, 23 2022 — 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, 23 2022 — 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 . . .

Nov, 23 2022 — No, but . . .  you may pay a higher premium each month due to your late enrollment penalty.  The Medicare Part D program is voluntary and you are not required to join a drug plan during your . . .

Nov, 23 2022 — Medicare Advantage plans provide coverage for Medicare Part A (in-patient, hospitalization), Medicare Part B (out-patient, doctor visits), and can include Medicare Part D prescription drug coverage (a . . .

Nov, 23 2022 — Yes.  In general, when you switch to a different Medicare Part D prescription drug plan (PDP or MAPD), your existing prescriptions will move to your new Medicare drug plan --- with a few exceptio . . .

Nov, 23 2022 — If you have recently enrolled in a Medicare plan and still have not received your new Medicare Part D or Medicare Advantage plan Member ID card, please contact your Medicare plan’s Member Serv . . .

Nov, 23 2022 — The annual Open Enrollment Period (AEP) or Annual Coordinated Election Period is the time when Medicare beneficiaries can add, change, or drop their Medicare Part D or Medicare Advantage plan coverage . . .

Nov, 20 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 . . .

Nov, 20 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.

Nov, 20 2022 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Nov, 20 2022 — 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 . . .

Nov, 20 2022 — Your Medicare Part D Initial Enrollment Period (IEP) is a seven (7) month window of time that starts three months before your Medicare eligibility month (or 65th birthday month), plus the month of your 65th birthday, and continues for three months after your eligibility month.

Nov, 20 2022 — Yes. There are two Medicare Advantage plan "trial periods" allowing you to return to a Medicare Supplement policy with guaranteed issue rights (no medical underwriting) - and, depending on where you live, your state may provide additional Medigap guaranteed issue rights

Nov, 20 2022 — No.  You are not responsible for a late-enrollment penalty (LEP) if you are now eligible for the Medicare Part D Extra Help or Low-Income Subsidy (LIS) program.   However, you may still . . .

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 . . .

Oct, 30 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 . . .

Aug, 27 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 ( . . .

Oct, 30 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 . . .

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.

Aug, 30 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 . . .

Nov, 05 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, 13 2022 — 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).  However, coverage (a . . .

Oct, 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 . . .

Nov, 10 2022 — 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.

Aug, 22 2022 — 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 . . .

Nov, 05 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 . . .

Oct, 27 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).

Nov, 09 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 . . .

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 . . .

Aug, 27 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 . . .