Q1Medicare.com - Medicare Prescription Drug Plans: FAQs

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

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 . . .

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 . . .

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 . . .

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 . . .

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.

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 . . .

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 . . .

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 . . .

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 . . .

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.

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 . . .

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 . . .

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 . . .

Our Q1Medicare® PDP-Compare and MA-Compare tools allow you to compare annual Medicare changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MA . . .

Your monthly Medicare Part D premium can be broken into two parts: the Basic and Supplemental Premiums.  And Medicare provides the technical definitions of Total Premium, Basic Premium, and Suppl . . .

You can get assistance choosing a Medicare plan from a number of sources. Call a Medicare representative If you wish to speak with someone about all of your Medicare Part D and Me . . .

Yes, some Medicare Advantage plans provide extended in-network coverage for people who split their time between two different states or geographic regions such as "snowbirds" or "sunbirds" who spend their year moving between the northern and southern states.

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 . . .

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 . . .

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 . . .

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 . . .

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 . . .

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 ( . . .

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.

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 . . .

Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs) . . .

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 . . .

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, . . .

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 . . .

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 . . .

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 . . .

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

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 . . .

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 . . .

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).

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 . . .

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 . . .

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 . . .

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 . . .